pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	mrx_tier_post_label_list	mrx_tier_post_benefit_type	mrx_tier_post_form_model_desc	mrx_tier_post_id	mrx_tier_post_type_id	mrx_tier_post_drug_type	mrx_tier_post_includes	mrx_tier_post_cost_struct	mrx_tier_post_copay_amt	mrx_tier_post_coins_pct	mrx_tier_post_includes_mmp	mrx_tier_post_copay_amt_mmpmin	mrx_tier_post_copay_amt_mmpmax
H0022	001	0	1	48	05	H0022_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H0022	001	0	1	48	05	H0022_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H0022	001	0	1	48	05	H0022_001_0	3	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H0028	007	0	1	01	01	H0028_007_0	6	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	007	0	1	01	01	H0028_007_0	6	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	007	0	1	01	01	H0028_007_0	6	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	007	0	1	01	01	H0028_007_0	6	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	007	0	1	01	01	H0028_007_0	6	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	011	0	1	01	01	H0028_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	011	0	1	01	01	H0028_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	011	0	1	01	01	H0028_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	011	0	1	01	01	H0028_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	011	0	1	01	01	H0028_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	013	0	1	01	01	H0028_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	013	0	1	01	01	H0028_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	013	0	1	01	01	H0028_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	013	0	1	01	01	H0028_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	013	0	1	01	01	H0028_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	014	0	1	01	01	H0028_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	014	0	1	01	01	H0028_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	014	0	1	01	01	H0028_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	014	0	1	01	01	H0028_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	014	0	1	01	01	H0028_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	015	0	1	01	01	H0028_015_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	015	0	1	01	01	H0028_015_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	015	0	1	01	01	H0028_015_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	015	0	1	01	01	H0028_015_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	015	0	1	01	01	H0028_015_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	016	0	1	01	01	H0028_016_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	016	0	1	01	01	H0028_016_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H0028	016	0	1	01	01	H0028_016_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	016	0	1	01	01	H0028_016_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	016	0	1	01	01	H0028_016_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	017	0	1	01	01	H0028_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	017	0	1	01	01	H0028_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H0028	017	0	1	01	01	H0028_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	017	0	1	01	01	H0028_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	017	0	1	01	01	H0028_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	018	0	1	01	01	H0028_018_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	018	0	1	01	01	H0028_018_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	018	0	1	01	01	H0028_018_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	018	0	1	01	01	H0028_018_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	018	0	1	01	01	H0028_018_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	019	0	1	01	01	H0028_019_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	019	0	1	01	01	H0028_019_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	019	0	1	01	01	H0028_019_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	019	0	1	01	01	H0028_019_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	019	0	1	01	01	H0028_019_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	021	0	1	01	01	H0028_021_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	021	0	1	01	01	H0028_021_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	021	0	1	01	01	H0028_021_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	021	0	1	01	01	H0028_021_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	021	0	1	01	01	H0028_021_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	023	0	1	01	01	H0028_023_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	023	0	1	01	01	H0028_023_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	023	0	1	01	01	H0028_023_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	023	0	1	01	01	H0028_023_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	023	0	1	01	01	H0028_023_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	024	0	1	01	01	H0028_024_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	024	0	1	01	01	H0028_024_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	024	0	1	01	01	H0028_024_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	024	0	1	01	01	H0028_024_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	024	0	1	01	01	H0028_024_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	025	1	1	01	01	H0028_025_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	025	1	1	01	01	H0028_025_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	025	1	1	01	01	H0028_025_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	025	1	1	01	01	H0028_025_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	025	1	1	01	01	H0028_025_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	025	2	1	01	01	H0028_025_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	025	2	1	01	01	H0028_025_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	025	2	1	01	01	H0028_025_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	025	2	1	01	01	H0028_025_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	025	2	1	01	01	H0028_025_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	027	0	1	01	01	H0028_027_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	027	0	1	01	01	H0028_027_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	027	0	1	01	01	H0028_027_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	027	0	1	01	01	H0028_027_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	027	0	1	01	01	H0028_027_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	028	0	1	01	01	H0028_028_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	028	0	1	01	01	H0028_028_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	028	0	1	01	01	H0028_028_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	028	0	1	01	01	H0028_028_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	028	0	1	01	01	H0028_028_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	029	0	1	01	01	H0028_029_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	029	0	1	01	01	H0028_029_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	029	0	1	01	01	H0028_029_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	029	0	1	01	01	H0028_029_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	029	0	1	01	01	H0028_029_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	030	0	1	01	01	H0028_030_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	030	0	1	01	01	H0028_030_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	030	0	1	01	01	H0028_030_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	030	0	1	01	01	H0028_030_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	030	0	1	01	01	H0028_030_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	031	0	1	01	01	H0028_031_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	031	0	1	01	01	H0028_031_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	031	0	1	01	01	H0028_031_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	031	0	1	01	01	H0028_031_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	031	0	1	01	01	H0028_031_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	032	0	1	01	01	H0028_032_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	032	0	1	01	01	H0028_032_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	032	0	1	01	01	H0028_032_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	032	0	1	01	01	H0028_032_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	032	0	1	01	01	H0028_032_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	033	0	1	01	01	H0028_033_0	5	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	033	0	1	01	01	H0028_033_0	5	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	033	0	1	01	01	H0028_033_0	5	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	033	0	1	01	01	H0028_033_0	5	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	033	0	1	01	01	H0028_033_0	5	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	034	0	1	01	01	H0028_034_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	034	0	1	01	01	H0028_034_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	034	0	1	01	01	H0028_034_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	034	0	1	01	01	H0028_034_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	034	0	1	01	01	H0028_034_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	035	0	1	01	01	H0028_035_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	035	0	1	01	01	H0028_035_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	035	0	1	01	01	H0028_035_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	035	0	1	01	01	H0028_035_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	035	0	1	01	01	H0028_035_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	036	0	1	01	01	H0028_036_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	036	0	1	01	01	H0028_036_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	036	0	1	01	01	H0028_036_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	036	0	1	01	01	H0028_036_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	036	0	1	01	01	H0028_036_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	037	0	1	01	01	H0028_037_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	037	0	1	01	01	H0028_037_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	037	0	1	01	01	H0028_037_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	037	0	1	01	01	H0028_037_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	037	0	1	01	01	H0028_037_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	039	0	1	01	01	H0028_039_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	039	0	1	01	01	H0028_039_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	039	0	1	01	01	H0028_039_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	039	0	1	01	01	H0028_039_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	039	0	1	01	01	H0028_039_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	041	0	1	01	01	H0028_041_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	041	0	1	01	01	H0028_041_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	041	0	1	01	01	H0028_041_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	041	0	1	01	01	H0028_041_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	041	0	1	01	01	H0028_041_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	042	0	1	01	01	H0028_042_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	042	0	1	01	01	H0028_042_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	042	0	1	01	01	H0028_042_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	042	0	1	01	01	H0028_042_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	042	0	1	01	01	H0028_042_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	043	1	1	01	01	H0028_043_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	043	1	1	01	01	H0028_043_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	043	1	1	01	01	H0028_043_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	043	1	1	01	01	H0028_043_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	043	1	1	01	01	H0028_043_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	043	2	1	01	01	H0028_043_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	043	2	1	01	01	H0028_043_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	043	2	1	01	01	H0028_043_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	043	2	1	01	01	H0028_043_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	043	2	1	01	01	H0028_043_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	044	0	1	01	01	H0028_044_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	044	0	1	01	01	H0028_044_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	044	0	1	01	01	H0028_044_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	044	0	1	01	01	H0028_044_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	044	0	1	01	01	H0028_044_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	045	0	1	01	01	H0028_045_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	045	0	1	01	01	H0028_045_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	045	0	1	01	01	H0028_045_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	045	0	1	01	01	H0028_045_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	045	0	1	01	01	H0028_045_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	046	0	1	01	01	H0028_046_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	046	0	1	01	01	H0028_046_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	046	0	1	01	01	H0028_046_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	046	0	1	01	01	H0028_046_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	046	0	1	01	01	H0028_046_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	047	0	1	01	01	H0028_047_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0028	047	0	1	01	01	H0028_047_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	047	0	1	01	01	H0028_047_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	047	0	1	01	01	H0028_047_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	047	0	1	01	01	H0028_047_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	048	1	1	01	01	H0028_048_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	048	1	1	01	01	H0028_048_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	048	1	1	01	01	H0028_048_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	048	1	1	01	01	H0028_048_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	048	1	1	01	01	H0028_048_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0028	048	2	1	01	01	H0028_048_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0028	048	2	1	01	01	H0028_048_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0028	048	2	1	01	01	H0028_048_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0028	048	2	1	01	01	H0028_048_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0028	048	2	1	01	01	H0028_048_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0062	001	0	1	01	01	H0062_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0062	001	0	1	01	01	H0062_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0062	001	0	1	01	01	H0062_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0062	001	0	1	01	01	H0062_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0062	001	0	1	01	01	H0062_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0062	001	0	1	01	01	H0062_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0062	002	0	1	01	01	H0062_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0062	002	0	1	01	01	H0062_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0062	002	0	1	01	01	H0062_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0062	002	0	1	01	01	H0062_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0062	002	0	1	01	01	H0062_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0062	002	0	1	01	01	H0062_002_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0062	003	0	1	01	01	H0062_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0062	003	0	1	01	01	H0062_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0062	003	0	1	01	01	H0062_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0062	003	0	1	01	01	H0062_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0062	003	0	1	01	01	H0062_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0062	003	0	1	01	01	H0062_003_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0074	001	0	1	04	01	H0074_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0074	001	0	1	04	01	H0074_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0074	001	0	1	04	01	H0074_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0074	001	0	1	04	01	H0074_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0074	001	0	1	04	01	H0074_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0088	001	0	1	04	01	H0088_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0088	001	0	1	04	01	H0088_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0088	001	0	1	04	01	H0088_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0088	001	0	1	04	01	H0088_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0088	001	0	1	04	01	H0088_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0088	002	0	1	04	01	H0088_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0088	002	0	1	04	01	H0088_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0088	002	0	1	04	01	H0088_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0088	002	0	1	04	01	H0088_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0088	002	0	1	04	01	H0088_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0104	012	0	1	04	01	H0104_012_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0104	012	0	1	04	01	H0104_012_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0104	012	0	1	04	01	H0104_012_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0104	012	0	1	04	01	H0104_012_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0104	012	0	1	04	01	H0104_012_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0104	012	0	1	04	01	H0104_012_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0104	014	0	1	04	01	H0104_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0104	014	0	1	04	01	H0104_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0104	014	0	1	04	01	H0104_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0104	014	0	1	04	01	H0104_014_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0104	014	0	1	04	01	H0104_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0104	014	0	1	04	01	H0104_014_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0104	015	0	1	04	01	H0104_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0104	015	0	1	04	01	H0104_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0104	015	0	1	04	01	H0104_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0104	015	0	1	04	01	H0104_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0104	015	0	1	04	01	H0104_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0104	015	0	1	04	01	H0104_015_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0107	003	0	1	04	01	H0107_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0107	003	0	1	04	01	H0107_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0107	003	0	1	04	01	H0107_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0107	003	0	1	04	01	H0107_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0107	003	0	1	04	01	H0107_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0107	004	0	1	04	01	H0107_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0107	004	0	1	04	01	H0107_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0107	004	0	1	04	01	H0107_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0107	004	0	1	04	01	H0107_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0107	004	0	1	04	01	H0107_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0111	001	0	1	04	01	H0111_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0111	001	0	1	04	01	H0111_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0111	001	0	1	04	01	H0111_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0111	001	0	1	04	01	H0111_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0111	001	0	1	04	01	H0111_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0111	002	0	1	04	01	H0111_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0111	002	0	1	04	01	H0111_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0111	002	0	1	04	01	H0111_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0111	002	0	1	04	01	H0111_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0111	002	0	1	04	01	H0111_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0111	003	0	1	04	01	H0111_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0111	003	0	1	04	01	H0111_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0111	003	0	1	04	01	H0111_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0111	003	0	1	04	01	H0111_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0111	003	0	1	04	01	H0111_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0111	004	0	1	04	01	H0111_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0111	004	0	1	04	01	H0111_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0111	004	0	1	04	01	H0111_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0111	004	0	1	04	01	H0111_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0111	004	0	1	04	01	H0111_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0111	005	0	1	04	01	H0111_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0111	005	0	1	04	01	H0111_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0111	005	0	1	04	01	H0111_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0111	005	0	1	04	01	H0111_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0111	005	0	1	04	01	H0111_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0137	001	0	1	48	05	H0137_001_0	4	Preferred Generic Drugs	4	Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H0137	001	0	1	48	05	H0137_001_0	4	Generic Drugs	4	Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	01					1	0.00	0.00
H0137	001	0	1	48	05	H0137_001_0	4	Preferred Brand Drugs	4	Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	10					1	0.00	0.00
H0137	001	0	1	48	05	H0137_001_0	4	Non-Preferred Brand Drugs	4	Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	4	2	11					1	0.00	0.00
H0137	001	0	1	48	05	H0137_001_0	4	Non-Medicare Rx/OTC Drugs	4	Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	5	2	11					2	0.00	0.00
H0148	001	0	1	48	05	H0148_001_0	6	Preferred Generic Drugs	4	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H0148	001	0	1	48	05	H0148_001_0	6	Generic Drugs	4	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	01					1	0.00	0.00
H0148	001	0	1	48	05	H0148_001_0	6	Brand Drugs	4	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	10					1	0.00	0.00
H0148	001	0	1	48	05	H0148_001_0	6	Non-Medicare Rx/OTC Drugs	4	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	4	2	11					2	0.00	0.00
H0148	002	0	1	48	05	H0148_002_0	6	Preferred Generic Drugs	4	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H0148	002	0	1	48	05	H0148_002_0	6	Generic Drugs	4	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	01					1	0.00	0.00
H0148	002	0	1	48	05	H0148_002_0	6	Brand Drugs	4	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	10					1	0.00	0.00
H0148	002	0	1	48	05	H0148_002_0	6	Non-Medicare Rx/OTC Drugs	4	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	4	2	11					2	0.00	0.00
H0154	011	0	1	01	01	H0154_011_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0154	011	0	1	01	01	H0154_011_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0154	011	0	1	01	01	H0154_011_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0154	011	0	1	01	01	H0154_011_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0154	011	0	1	01	01	H0154_011_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0154	012	0	1	01	01	H0154_012_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0154	012	0	1	01	01	H0154_012_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0154	012	0	1	01	01	H0154_012_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0154	012	0	1	01	01	H0154_012_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0154	012	0	1	01	01	H0154_012_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0154	014	0	1	01	01	H0154_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0154	014	0	1	01	01	H0154_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0154	014	0	1	01	01	H0154_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0154	014	0	1	01	01	H0154_014_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0154	014	0	1	01	01	H0154_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0154	015	1	1	01	01	H0154_015_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0154	015	1	1	01	01	H0154_015_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0154	015	1	1	01	01	H0154_015_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0154	015	1	1	01	01	H0154_015_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0154	015	1	1	01	01	H0154_015_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0154	015	2	1	01	01	H0154_015_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0154	015	2	1	01	01	H0154_015_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0154	015	2	1	01	01	H0154_015_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0154	015	2	1	01	01	H0154_015_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0154	015	2	1	01	01	H0154_015_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0154	016	0	1	01	01	H0154_016_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0154	016	0	1	01	01	H0154_016_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0154	016	0	1	01	01	H0154_016_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0154	016	0	1	01	01	H0154_016_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0154	016	0	1	01	01	H0154_016_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0154	017	0	1	01	01	H0154_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0154	017	0	1	01	01	H0154_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0154	017	0	1	01	01	H0154_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0154	017	0	1	01	01	H0154_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0154	017	0	1	01	01	H0154_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0154	018	0	1	01	01	H0154_018_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0154	018	0	1	01	01	H0154_018_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0154	018	0	1	01	01	H0154_018_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0154	018	0	1	01	01	H0154_018_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0154	018	0	1	01	01	H0154_018_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0154	019	0	1	01	01	H0154_019_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0154	019	0	1	01	01	H0154_019_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0154	019	0	1	01	01	H0154_019_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0154	019	0	1	01	01	H0154_019_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0154	019	0	1	01	01	H0154_019_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0174	002	0	1	01	01	H0174_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0174	002	0	1	01	01	H0174_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0174	002	0	1	01	01	H0174_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0174	002	0	1	01	01	H0174_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0174	002	0	1	01	01	H0174_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0174	003	0	1	01	01	H0174_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0174	003	0	1	01	01	H0174_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0174	003	0	1	01	01	H0174_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0174	003	0	1	01	01	H0174_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0174	003	0	1	01	01	H0174_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0174	004	0	1	01	01	H0174_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0174	004	0	1	01	01	H0174_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0174	004	0	1	01	01	H0174_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0174	004	0	1	01	01	H0174_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0174	004	0	1	01	01	H0174_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0174	005	0	1	02	01	H0174_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0174	005	0	1	02	01	H0174_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0174	005	0	1	02	01	H0174_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0174	005	0	1	02	01	H0174_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0174	005	0	1	02	01	H0174_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0174	006	0	1	01	01	H0174_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0174	006	0	1	01	01	H0174_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0174	006	0	1	01	01	H0174_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0174	006	0	1	01	01	H0174_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0174	006	0	1	01	01	H0174_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0174	007	0	1	01	01	H0174_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0174	007	0	1	01	01	H0174_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0174	007	0	1	01	01	H0174_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0174	007	0	1	01	01	H0174_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0174	007	0	1	01	01	H0174_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0174	008	0	1	01	01	H0174_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H0174	008	0	1	01	01	H0174_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H0174	008	0	1	01	01	H0174_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0174	008	0	1	01	01	H0174_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0174	008	0	1	01	01	H0174_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0174	008	0	1	01	01	H0174_008_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0174	009	0	1	01	01	H0174_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0174	009	0	1	01	01	H0174_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0174	009	0	1	01	01	H0174_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0174	009	0	1	01	01	H0174_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0174	009	0	1	01	01	H0174_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0174	010	0	1	01	01	H0174_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0174	010	0	1	01	01	H0174_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0174	010	0	1	01	01	H0174_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0174	010	0	1	01	01	H0174_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0174	010	0	1	01	01	H0174_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0192	001	0	1	48	05	H0192_001_0	4	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H0192	001	0	1	48	05	H0192_001_0	4	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H0192	001	0	1	48	05	H0192_001_0	4	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H0270	001	0	1	04	01	H0270_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0270	001	0	1	04	01	H0270_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0270	001	0	1	04	01	H0270_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0270	001	0	1	04	01	H0270_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0270	001	0	1	04	01	H0270_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0270	002	0	1	04	01	H0270_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0270	002	0	1	04	01	H0270_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0270	002	0	1	04	01	H0270_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0270	002	0	1	04	01	H0270_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0270	002	0	1	04	01	H0270_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0292	001	0	1	01	01	H0292_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0292	001	0	1	01	01	H0292_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0292	001	0	1	01	01	H0292_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0292	001	0	1	01	01	H0292_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0292	001	0	1	01	01	H0292_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0292	002	0	1	01	01	H0292_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0292	002	0	1	01	01	H0292_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0292	002	0	1	01	01	H0292_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0292	002	0	1	01	01	H0292_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0292	002	0	1	01	01	H0292_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0294	002	0	1	04	01	H0294_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0294	002	0	1	04	01	H0294_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0294	002	0	1	04	01	H0294_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0294	002	0	1	04	01	H0294_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0294	002	0	1	04	01	H0294_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0294	004	0	1	04	01	H0294_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0294	004	0	1	04	01	H0294_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0294	004	0	1	04	01	H0294_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0294	004	0	1	04	01	H0294_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0294	004	0	1	04	01	H0294_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0294	010	0	1	04	01	H0294_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0294	010	0	1	04	01	H0294_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0294	010	0	1	04	01	H0294_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0294	010	0	1	04	01	H0294_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0294	010	0	1	04	01	H0294_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0294	011	0	1	04	01	H0294_011_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0294	011	0	1	04	01	H0294_011_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0294	011	0	1	04	01	H0294_011_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0294	011	0	1	04	01	H0294_011_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0294	011	0	1	04	01	H0294_011_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0294	012	0	1	04	01	H0294_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0294	012	0	1	04	01	H0294_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0294	012	0	1	04	01	H0294_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0294	012	0	1	04	01	H0294_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0294	012	0	1	04	01	H0294_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0294	015	0	1	04	01	H0294_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0294	015	0	1	04	01	H0294_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0294	015	0	1	04	01	H0294_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0294	015	0	1	04	01	H0294_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0294	015	0	1	04	01	H0294_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0294	016	0	1	04	01	H0294_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0294	016	0	1	04	01	H0294_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0294	016	0	1	04	01	H0294_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0294	016	0	1	04	01	H0294_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0294	016	0	1	04	01	H0294_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0294	017	0	1	04	01	H0294_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0294	017	0	1	04	01	H0294_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0294	017	0	1	04	01	H0294_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0294	017	0	1	04	01	H0294_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0294	017	0	1	04	01	H0294_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0302	001	0	1	01	01	H0302_001_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H0302	001	0	1	01	01	H0302_001_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H0302	001	0	1	01	01	H0302_001_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H0302	001	0	1	01	01	H0302_001_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H0302	001	0	1	01	01	H0302_001_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H0302	006	0	1	01	01	H0302_006_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H0302	006	0	1	01	01	H0302_006_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H0302	006	0	1	01	01	H0302_006_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H0302	006	0	1	01	01	H0302_006_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H0302	006	0	1	01	01	H0302_006_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H0302	008	0	1	01	01	H0302_008_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H0302	008	0	1	01	01	H0302_008_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H0302	008	0	1	01	01	H0302_008_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H0302	008	0	1	01	01	H0302_008_0	13	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H0302	008	0	1	01	01	H0302_008_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H0302	009	0	1	01	01	H0302_009_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H0302	009	0	1	01	01	H0302_009_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H0302	009	0	1	01	01	H0302_009_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H0302	009	0	1	01	01	H0302_009_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H0302	009	0	1	01	01	H0302_009_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H0332	002	0	1	01	01	H0332_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0332	002	0	1	01	01	H0332_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0332	002	0	1	01	01	H0332_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0332	002	0	1	01	01	H0332_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0332	002	0	1	01	01	H0332_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0332	004	0	1	02	01	H0332_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0332	004	0	1	02	01	H0332_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0332	004	0	1	02	01	H0332_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0332	004	0	1	02	01	H0332_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0332	004	0	1	02	01	H0332_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0332	008	0	1	02	01	H0332_008_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0332	008	0	1	02	01	H0332_008_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0332	008	0	1	02	01	H0332_008_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0332	008	0	1	02	01	H0332_008_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0332	008	0	1	02	01	H0332_008_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0336	001	0	1	48	05	H0336_001_0	2	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	2	01					1	0.00	0.00
H0336	001	0	1	48	05	H0336_001_0	2	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	2	10					1	0.00	0.00
H0336	001	0	1	48	05	H0336_001_0	2	Non-Medicare Rx Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	3	2	11					2	0.00	0.00
H0336	001	0	1	48	05	H0336_001_0	2	Non-Medicare OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	4	2	11					2	0.00	0.00
H0342	001	0	1	04	01	H0342_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H0342	001	0	1	04	01	H0342_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H0342	001	0	1	04	01	H0342_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H0342	001	0	1	04	01	H0342_001_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H0342	001	0	1	04	01	H0342_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H0342	001	0	1	04	01	H0342_001_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H0351	038	0	1	01	01	H0351_038_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0351	038	0	1	01	01	H0351_038_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0351	038	0	1	01	01	H0351_038_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0351	038	0	1	01	01	H0351_038_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0351	038	0	1	01	01	H0351_038_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0351	038	0	1	01	01	H0351_038_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0351	052	0	1	01	01	H0351_052_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0351	052	0	1	01	01	H0351_052_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0351	052	0	1	01	01	H0351_052_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0351	052	0	1	01	01	H0351_052_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0351	052	0	1	01	01	H0351_052_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0351	052	0	1	01	01	H0351_052_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0351	053	0	1	01	01	H0351_053_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0351	053	0	1	01	01	H0351_053_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0351	053	0	1	01	01	H0351_053_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0351	053	0	1	01	01	H0351_053_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0351	053	0	1	01	01	H0351_053_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0351	053	0	1	01	01	H0351_053_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0351	054	0	1	01	01	H0351_054_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0351	054	0	1	01	01	H0351_054_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0351	054	0	1	01	01	H0351_054_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0351	054	0	1	01	01	H0351_054_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0351	054	0	1	01	01	H0351_054_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0351	054	0	1	01	01	H0351_054_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0354	001	0	1	01	01	H0354_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0354	001	0	1	01	01	H0354_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0354	001	0	1	01	01	H0354_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0354	001	0	1	01	01	H0354_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0354	001	0	1	01	01	H0354_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0354	024	0	1	01	01	H0354_024_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0354	024	0	1	01	01	H0354_024_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0354	024	0	1	01	01	H0354_024_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0354	024	0	1	01	01	H0354_024_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0354	024	0	1	01	01	H0354_024_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0354	027	0	1	01	01	H0354_027_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H0354	027	0	1	01	01	H0354_027_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	01	1						
H0354	027	0	1	01	01	H0354_027_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	1						
H0354	027	0	1	01	01	H0354_027_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H0354	027	0	1	01	01	H0354_027_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H0354	027	0	1	01	01	H0354_027_0	5	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H0354	028	0	1	01	01	H0354_028_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0354	028	0	1	01	01	H0354_028_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0354	028	0	1	01	01	H0354_028_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0354	028	0	1	01	01	H0354_028_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0354	028	0	1	01	01	H0354_028_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0422	001	0	1	02	01	H0422_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0422	001	0	1	02	01	H0422_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0422	001	0	1	02	01	H0422_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0422	001	0	1	02	01	H0422_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0422	001	0	1	02	01	H0422_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0422	002	0	1	02	01	H0422_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0422	002	0	1	02	01	H0422_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0422	002	0	1	02	01	H0422_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0422	002	0	1	02	01	H0422_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0422	002	0	1	02	01	H0422_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0432	001	0	1	01	01	H0432_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0432	001	0	1	01	01	H0432_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0432	001	0	1	01	01	H0432_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0432	001	0	1	01	01	H0432_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0432	001	0	1	01	01	H0432_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0432	002	0	1	01	01	H0432_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0432	002	0	1	01	01	H0432_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0432	002	0	1	01	01	H0432_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0432	002	0	1	01	01	H0432_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0432	002	0	1	01	01	H0432_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0432	003	0	1	01	01	H0432_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0432	003	0	1	01	01	H0432_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0432	003	0	1	01	01	H0432_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0432	003	0	1	01	01	H0432_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0432	003	0	1	01	01	H0432_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0432	004	0	1	01	01	H0432_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0432	004	0	1	01	01	H0432_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0432	004	0	1	01	01	H0432_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0432	004	0	1	01	01	H0432_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0432	004	0	1	01	01	H0432_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0432	010	0	1	01	01	H0432_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0432	010	0	1	01	01	H0432_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0432	010	0	1	01	01	H0432_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0432	010	0	1	01	01	H0432_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0432	010	0	1	01	01	H0432_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0439	003	1	1	01	01	H0439_003_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0439	003	1	1	01	01	H0439_003_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0439	003	1	1	01	01	H0439_003_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0439	003	1	1	01	01	H0439_003_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0439	003	1	1	01	01	H0439_003_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0439	003	2	1	01	01	H0439_003_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0439	003	2	1	01	01	H0439_003_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0439	003	2	1	01	01	H0439_003_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0439	003	2	1	01	01	H0439_003_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0439	003	2	1	01	01	H0439_003_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0439	006	0	1	02	01	H0439_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0439	006	0	1	02	01	H0439_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0439	006	0	1	02	01	H0439_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0439	006	0	1	02	01	H0439_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0439	006	0	1	02	01	H0439_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0439	007	0	1	01	01	H0439_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0439	007	0	1	01	01	H0439_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0439	007	0	1	01	01	H0439_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0439	007	0	1	01	01	H0439_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0439	007	0	1	01	01	H0439_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0439	008	0	1	01	01	H0439_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0439	008	0	1	01	01	H0439_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0439	008	0	1	01	01	H0439_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0439	008	0	1	01	01	H0439_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0439	008	0	1	01	01	H0439_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0439	009	0	1	01	01	H0439_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0439	009	0	1	01	01	H0439_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0439	009	0	1	01	01	H0439_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0439	009	0	1	01	01	H0439_009_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0439	009	0	1	01	01	H0439_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0439	010	0	1	01	01	H0439_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0439	010	0	1	01	01	H0439_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0439	010	0	1	01	01	H0439_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0439	010	0	1	01	01	H0439_010_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0439	010	0	1	01	01	H0439_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0439	011	0	1	01	01	H0439_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0439	011	0	1	01	01	H0439_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0439	011	0	1	01	01	H0439_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0439	011	0	1	01	01	H0439_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0439	011	0	1	01	01	H0439_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0473	001	0	1	04	01	H0473_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0473	001	0	1	04	01	H0473_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0473	001	0	1	04	01	H0473_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0473	001	0	1	04	01	H0473_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0473	001	0	1	04	01	H0473_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0473	003	0	1	04	01	H0473_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0473	003	0	1	04	01	H0473_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0473	003	0	1	04	01	H0473_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0473	003	0	1	04	01	H0473_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0473	003	0	1	04	01	H0473_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0473	004	0	1	04	01	H0473_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0473	004	0	1	04	01	H0473_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0473	004	0	1	04	01	H0473_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0473	004	0	1	04	01	H0473_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0473	004	0	1	04	01	H0473_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0473	005	0	1	04	01	H0473_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0473	005	0	1	04	01	H0473_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0473	005	0	1	04	01	H0473_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0473	005	0	1	04	01	H0473_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0473	005	0	1	04	01	H0473_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0473	006	0	1	04	01	H0473_006_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0473	006	0	1	04	01	H0473_006_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0473	006	0	1	04	01	H0473_006_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0473	006	0	1	04	01	H0473_006_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0473	006	0	1	04	01	H0473_006_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0480	001	0	1	48	05	H0480_001_0	5	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H0480	001	0	1	48	05	H0480_001_0	5	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H0480	001	0	1	48	05	H0480_001_0	5	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H0482	001	0	1	01	01	H0482_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0482	001	0	1	01	01	H0482_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0482	001	0	1	01	01	H0482_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0482	001	0	1	01	01	H0482_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0482	001	0	1	01	01	H0482_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0482	001	0	1	01	01	H0482_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0482	002	0	1	01	01	H0482_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0482	002	0	1	01	01	H0482_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0482	002	0	1	01	01	H0482_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0482	002	0	1	01	01	H0482_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0482	002	0	1	01	01	H0482_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0482	002	0	1	01	01	H0482_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0504	015	0	1	01	01	H0504_015_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	015	0	1	01	01	H0504_015_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	015	0	1	01	01	H0504_015_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	015	0	1	01	01	H0504_015_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	015	0	1	01	01	H0504_015_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	017	0	1	01	01	H0504_017_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	017	0	1	01	01	H0504_017_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	017	0	1	01	01	H0504_017_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	017	0	1	01	01	H0504_017_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	017	0	1	01	01	H0504_017_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	021	0	1	01	01	H0504_021_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	021	0	1	01	01	H0504_021_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	021	0	1	01	01	H0504_021_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	021	0	1	01	01	H0504_021_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	021	0	1	01	01	H0504_021_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	026	0	1	01	01	H0504_026_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	026	0	1	01	01	H0504_026_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	026	0	1	01	01	H0504_026_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	026	0	1	01	01	H0504_026_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	026	0	1	01	01	H0504_026_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	028	0	1	01	01	H0504_028_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	028	0	1	01	01	H0504_028_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	028	0	1	01	01	H0504_028_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	028	0	1	01	01	H0504_028_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	028	0	1	01	01	H0504_028_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	029	0	1	01	01	H0504_029_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	029	0	1	01	01	H0504_029_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	029	0	1	01	01	H0504_029_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	029	0	1	01	01	H0504_029_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	029	0	1	01	01	H0504_029_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	031	0	1	01	01	H0504_031_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	031	0	1	01	01	H0504_031_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	031	0	1	01	01	H0504_031_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	031	0	1	01	01	H0504_031_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	031	0	1	01	01	H0504_031_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	037	0	1	01	01	H0504_037_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	037	0	1	01	01	H0504_037_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	037	0	1	01	01	H0504_037_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	037	0	1	01	01	H0504_037_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	037	0	1	01	01	H0504_037_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	038	0	1	01	01	H0504_038_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	038	0	1	01	01	H0504_038_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	038	0	1	01	01	H0504_038_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	038	0	1	01	01	H0504_038_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	038	0	1	01	01	H0504_038_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	039	0	1	01	01	H0504_039_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	039	0	1	01	01	H0504_039_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	039	0	1	01	01	H0504_039_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	039	0	1	01	01	H0504_039_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	039	0	1	01	01	H0504_039_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	040	0	1	01	01	H0504_040_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	040	0	1	01	01	H0504_040_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	040	0	1	01	01	H0504_040_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	040	0	1	01	01	H0504_040_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	040	0	1	01	01	H0504_040_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	041	0	1	01	01	H0504_041_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	041	0	1	01	01	H0504_041_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	041	0	1	01	01	H0504_041_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	041	0	1	01	01	H0504_041_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	041	0	1	01	01	H0504_041_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	042	0	1	01	01	H0504_042_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	042	0	1	01	01	H0504_042_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	042	0	1	01	01	H0504_042_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	042	0	1	01	01	H0504_042_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	042	0	1	01	01	H0504_042_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	043	0	1	01	01	H0504_043_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	043	0	1	01	01	H0504_043_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	043	0	1	01	01	H0504_043_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	043	0	1	01	01	H0504_043_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	043	0	1	01	01	H0504_043_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	044	0	1	01	01	H0504_044_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	044	0	1	01	01	H0504_044_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	044	0	1	01	01	H0504_044_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	044	0	1	01	01	H0504_044_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	044	0	1	01	01	H0504_044_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	045	0	1	01	01	H0504_045_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	045	0	1	01	01	H0504_045_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	045	0	1	01	01	H0504_045_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	045	0	1	01	01	H0504_045_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	045	0	1	01	01	H0504_045_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	046	0	1	01	01	H0504_046_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	046	0	1	01	01	H0504_046_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	046	0	1	01	01	H0504_046_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	046	0	1	01	01	H0504_046_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	046	0	1	01	01	H0504_046_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0504	047	0	1	01	01	H0504_047_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0504	047	0	1	01	01	H0504_047_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0504	047	0	1	01	01	H0504_047_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0504	047	0	1	01	01	H0504_047_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0504	047	0	1	01	01	H0504_047_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0523	002	0	1	01	01	H0523_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0523	002	0	1	01	01	H0523_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0523	002	0	1	01	01	H0523_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0523	002	0	1	01	01	H0523_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0523	002	0	1	01	01	H0523_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0523	022	0	1	01	01	H0523_022_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0523	022	0	1	01	01	H0523_022_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0523	022	0	1	01	01	H0523_022_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0523	022	0	1	01	01	H0523_022_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0523	022	0	1	01	01	H0523_022_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0523	031	0	1	01	01	H0523_031_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0523	031	0	1	01	01	H0523_031_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0523	031	0	1	01	01	H0523_031_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0523	031	0	1	01	01	H0523_031_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0523	031	0	1	01	01	H0523_031_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0523	052	0	1	01	01	H0523_052_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0523	052	0	1	01	01	H0523_052_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0523	052	0	1	01	01	H0523_052_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0523	052	0	1	01	01	H0523_052_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0523	052	0	1	01	01	H0523_052_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0523	061	0	1	01	01	H0523_061_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0523	061	0	1	01	01	H0523_061_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0523	061	0	1	01	01	H0523_061_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0523	061	0	1	01	01	H0523_061_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0523	061	0	1	01	01	H0523_061_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0524	002	0	2	01	01	H0524_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	002	0	2	01	01	H0524_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	002	0	2	01	01	H0524_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	002	0	2	01	01	H0524_002_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	002	0	2	01	01	H0524_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	002	0	2	01	01	H0524_002_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	003	0	1	01	01	H0524_003_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	003	0	1	01	01	H0524_003_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	003	0	1	01	01	H0524_003_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	003	0	1	01	01	H0524_003_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	003	0	1	01	01	H0524_003_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	003	0	1	01	01	H0524_003_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	008	0	1	01	01	H0524_008_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	008	0	1	01	01	H0524_008_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	008	0	1	01	01	H0524_008_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	008	0	1	01	01	H0524_008_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	008	0	1	01	01	H0524_008_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	008	0	1	01	01	H0524_008_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	010	0	2	01	01	H0524_010_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	010	0	2	01	01	H0524_010_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	010	0	2	01	01	H0524_010_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	010	0	2	01	01	H0524_010_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	010	0	2	01	01	H0524_010_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	010	0	2	01	01	H0524_010_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	013	0	1	01	01	H0524_013_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	013	0	1	01	01	H0524_013_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	013	0	1	01	01	H0524_013_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	013	0	1	01	01	H0524_013_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	013	0	1	01	01	H0524_013_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	013	0	1	01	01	H0524_013_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	015	0	1	01	01	H0524_015_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	015	0	1	01	01	H0524_015_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	015	0	1	01	01	H0524_015_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	015	0	1	01	01	H0524_015_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	015	0	1	01	01	H0524_015_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	015	0	1	01	01	H0524_015_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	031	0	1	01	01	H0524_031_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	031	0	1	01	01	H0524_031_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	031	0	1	01	01	H0524_031_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	031	0	1	01	01	H0524_031_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	031	0	1	01	01	H0524_031_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	031	0	1	01	01	H0524_031_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	032	0	1	01	01	H0524_032_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	032	0	1	01	01	H0524_032_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	032	0	1	01	01	H0524_032_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	032	0	1	01	01	H0524_032_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	032	0	1	01	01	H0524_032_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	032	0	1	01	01	H0524_032_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	033	0	1	01	01	H0524_033_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	033	0	1	01	01	H0524_033_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	033	0	1	01	01	H0524_033_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	033	0	1	01	01	H0524_033_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	033	0	1	01	01	H0524_033_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	033	0	1	01	01	H0524_033_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	034	0	1	01	01	H0524_034_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	034	0	1	01	01	H0524_034_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	034	0	1	01	01	H0524_034_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	034	0	1	01	01	H0524_034_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	034	0	1	01	01	H0524_034_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	034	0	1	01	01	H0524_034_0	10	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	035	0	1	01	01	H0524_035_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	0.00				
H0524	035	0	1	01	01	H0524_035_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	035	0	1	01	01	H0524_035_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	035	0	1	01	01	H0524_035_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	035	0	1	01	01	H0524_035_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	035	0	1	01	01	H0524_035_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	036	0	1	01	01	H0524_036_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	0.00				
H0524	036	0	1	01	01	H0524_036_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	036	0	1	01	01	H0524_036_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	036	0	1	01	01	H0524_036_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	036	0	1	01	01	H0524_036_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	036	0	1	01	01	H0524_036_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	037	0	1	01	01	H0524_037_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	037	0	1	01	01	H0524_037_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	037	0	1	01	01	H0524_037_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	037	0	1	01	01	H0524_037_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	037	0	1	01	01	H0524_037_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	037	0	1	01	01	H0524_037_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	038	0	1	01	01	H0524_038_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	038	0	1	01	01	H0524_038_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	038	0	1	01	01	H0524_038_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	038	0	1	01	01	H0524_038_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	038	0	1	01	01	H0524_038_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	038	0	1	01	01	H0524_038_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	039	0	1	01	01	H0524_039_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	039	0	1	01	01	H0524_039_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	039	0	1	01	01	H0524_039_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	039	0	1	01	01	H0524_039_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	039	0	1	01	01	H0524_039_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	039	0	1	01	01	H0524_039_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	040	0	1	01	01	H0524_040_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	040	0	1	01	01	H0524_040_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	040	0	1	01	01	H0524_040_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	040	0	1	01	01	H0524_040_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	040	0	1	01	01	H0524_040_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	040	0	1	01	01	H0524_040_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	041	0	1	01	01	H0524_041_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	041	0	1	01	01	H0524_041_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	041	0	1	01	01	H0524_041_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	041	0	1	01	01	H0524_041_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	041	0	1	01	01	H0524_041_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	041	0	1	01	01	H0524_041_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	042	0	1	01	01	H0524_042_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	042	0	1	01	01	H0524_042_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	042	0	1	01	01	H0524_042_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	042	0	1	01	01	H0524_042_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	042	0	1	01	01	H0524_042_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	042	0	1	01	01	H0524_042_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	043	0	1	01	01	H0524_043_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	043	0	1	01	01	H0524_043_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	043	0	1	01	01	H0524_043_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	043	0	1	01	01	H0524_043_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	043	0	1	01	01	H0524_043_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	043	0	1	01	01	H0524_043_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	046	0	1	01	01	H0524_046_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	046	0	1	01	01	H0524_046_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	046	0	1	01	01	H0524_046_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	046	0	1	01	01	H0524_046_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	046	0	1	01	01	H0524_046_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	046	0	1	01	01	H0524_046_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	051	0	1	01	01	H0524_051_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	051	0	1	01	01	H0524_051_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	051	0	1	01	01	H0524_051_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	051	0	1	01	01	H0524_051_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	051	0	1	01	01	H0524_051_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	051	0	1	01	01	H0524_051_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	054	0	1	01	01	H0524_054_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	054	0	1	01	01	H0524_054_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	054	0	1	01	01	H0524_054_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	054	0	1	01	01	H0524_054_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	054	0	1	01	01	H0524_054_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	054	0	1	01	01	H0524_054_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	059	0	1	01	01	H0524_059_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	059	0	1	01	01	H0524_059_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	059	0	1	01	01	H0524_059_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	059	0	1	01	01	H0524_059_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	059	0	1	01	01	H0524_059_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	059	0	1	01	01	H0524_059_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	060	0	1	01	01	H0524_060_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	060	0	1	01	01	H0524_060_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	060	0	1	01	01	H0524_060_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	060	0	1	01	01	H0524_060_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	060	0	1	01	01	H0524_060_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	060	0	1	01	01	H0524_060_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	061	0	1	01	01	H0524_061_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	061	0	1	01	01	H0524_061_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	061	0	1	01	01	H0524_061_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	061	0	1	01	01	H0524_061_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	061	0	1	01	01	H0524_061_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	061	0	1	01	01	H0524_061_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0524	062	0	1	01	01	H0524_062_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	3.00				
H0524	062	0	1	01	01	H0524_062_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	3.00				
H0524	062	0	1	01	01	H0524_062_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	12.00				
H0524	062	0	1	01	01	H0524_062_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	12.00				
H0524	062	0	1	01	01	H0524_062_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	12.00				
H0524	062	0	1	01	01	H0524_062_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H0543	001	0	1	01	01	H0543_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	001	0	1	01	01	H0543_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	001	0	1	01	01	H0543_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	001	0	1	01	01	H0543_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	001	0	1	01	01	H0543_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	013	0	1	01	01	H0543_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	013	0	1	01	01	H0543_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	013	0	1	01	01	H0543_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	013	0	1	01	01	H0543_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	013	0	1	01	01	H0543_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	019	0	1	01	01	H0543_019_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	019	0	1	01	01	H0543_019_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	019	0	1	01	01	H0543_019_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	019	0	1	01	01	H0543_019_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	019	0	1	01	01	H0543_019_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	022	0	1	01	01	H0543_022_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	022	0	1	01	01	H0543_022_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	022	0	1	01	01	H0543_022_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	022	0	1	01	01	H0543_022_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	022	0	1	01	01	H0543_022_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	028	0	1	01	01	H0543_028_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	028	0	1	01	01	H0543_028_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	028	0	1	01	01	H0543_028_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	028	0	1	01	01	H0543_028_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	028	0	1	01	01	H0543_028_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	029	0	1	01	01	H0543_029_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	029	0	1	01	01	H0543_029_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	029	0	1	01	01	H0543_029_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	029	0	1	01	01	H0543_029_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	029	0	1	01	01	H0543_029_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	032	0	1	01	01	H0543_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	032	0	1	01	01	H0543_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	032	0	1	01	01	H0543_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	032	0	1	01	01	H0543_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	032	0	1	01	01	H0543_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	035	0	1	01	01	H0543_035_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	035	0	1	01	01	H0543_035_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	035	0	1	01	01	H0543_035_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	035	0	1	01	01	H0543_035_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	035	0	1	01	01	H0543_035_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	036	0	1	01	01	H0543_036_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	036	0	1	01	01	H0543_036_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	036	0	1	01	01	H0543_036_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	036	0	1	01	01	H0543_036_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	036	0	1	01	01	H0543_036_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	060	0	1	01	01	H0543_060_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	060	0	1	01	01	H0543_060_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	060	0	1	01	01	H0543_060_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	060	0	1	01	01	H0543_060_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	060	0	1	01	01	H0543_060_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	070	0	1	01	01	H0543_070_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	070	0	1	01	01	H0543_070_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	070	0	1	01	01	H0543_070_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	070	0	1	01	01	H0543_070_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	070	0	1	01	01	H0543_070_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	086	0	1	01	01	H0543_086_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	086	0	1	01	01	H0543_086_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	086	0	1	01	01	H0543_086_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	086	0	1	01	01	H0543_086_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	086	0	1	01	01	H0543_086_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	089	0	1	01	01	H0543_089_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	089	0	1	01	01	H0543_089_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	089	0	1	01	01	H0543_089_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	089	0	1	01	01	H0543_089_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	089	0	1	01	01	H0543_089_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	138	0	1	01	01	H0543_138_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	138	0	1	01	01	H0543_138_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	138	0	1	01	01	H0543_138_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	138	0	1	01	01	H0543_138_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	138	0	1	01	01	H0543_138_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	140	0	1	01	01	H0543_140_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	140	0	1	01	01	H0543_140_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	140	0	1	01	01	H0543_140_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	140	0	1	01	01	H0543_140_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	140	0	1	01	01	H0543_140_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	144	0	1	01	01	H0543_144_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	144	0	1	01	01	H0543_144_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	144	0	1	01	01	H0543_144_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	144	0	1	01	01	H0543_144_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	144	0	1	01	01	H0543_144_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	145	0	1	01	01	H0543_145_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	145	0	1	01	01	H0543_145_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	145	0	1	01	01	H0543_145_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	145	0	1	01	01	H0543_145_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	145	0	1	01	01	H0543_145_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	146	0	1	01	01	H0543_146_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	146	0	1	01	01	H0543_146_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	146	0	1	01	01	H0543_146_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	146	0	1	01	01	H0543_146_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	146	0	1	01	01	H0543_146_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	147	0	1	01	01	H0543_147_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	147	0	1	01	01	H0543_147_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	147	0	1	01	01	H0543_147_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	147	0	1	01	01	H0543_147_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	147	0	1	01	01	H0543_147_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	148	0	1	01	01	H0543_148_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	148	0	1	01	01	H0543_148_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	148	0	1	01	01	H0543_148_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	148	0	1	01	01	H0543_148_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	148	0	1	01	01	H0543_148_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	151	0	1	01	01	H0543_151_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	151	0	1	01	01	H0543_151_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	151	0	1	01	01	H0543_151_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	151	0	1	01	01	H0543_151_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	151	0	1	01	01	H0543_151_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	152	0	1	01	01	H0543_152_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	152	0	1	01	01	H0543_152_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	152	0	1	01	01	H0543_152_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	152	0	1	01	01	H0543_152_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	152	0	1	01	01	H0543_152_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	158	0	1	01	01	H0543_158_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	158	0	1	01	01	H0543_158_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	158	0	1	01	01	H0543_158_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	158	0	1	01	01	H0543_158_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	158	0	1	01	01	H0543_158_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	163	0	1	01	01	H0543_163_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	163	0	1	01	01	H0543_163_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	163	0	1	01	01	H0543_163_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	163	0	1	01	01	H0543_163_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	163	0	1	01	01	H0543_163_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	164	0	1	01	01	H0543_164_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	164	0	1	01	01	H0543_164_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	164	0	1	01	01	H0543_164_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	164	0	1	01	01	H0543_164_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	164	0	1	01	01	H0543_164_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	165	0	1	01	01	H0543_165_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	165	0	1	01	01	H0543_165_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	165	0	1	01	01	H0543_165_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	165	0	1	01	01	H0543_165_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	165	0	1	01	01	H0543_165_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	166	0	1	01	01	H0543_166_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	166	0	1	01	01	H0543_166_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	166	0	1	01	01	H0543_166_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	166	0	1	01	01	H0543_166_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	166	0	1	01	01	H0543_166_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	167	0	1	01	01	H0543_167_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	167	0	1	01	01	H0543_167_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	167	0	1	01	01	H0543_167_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	167	0	1	01	01	H0543_167_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	167	0	1	01	01	H0543_167_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	168	0	1	01	01	H0543_168_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	168	0	1	01	01	H0543_168_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	168	0	1	01	01	H0543_168_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	168	0	1	01	01	H0543_168_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	168	0	1	01	01	H0543_168_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	169	0	1	01	01	H0543_169_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	169	0	1	01	01	H0543_169_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	169	0	1	01	01	H0543_169_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	169	0	1	01	01	H0543_169_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	169	0	1	01	01	H0543_169_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	170	0	1	01	01	H0543_170_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	170	0	1	01	01	H0543_170_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	170	0	1	01	01	H0543_170_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	170	0	1	01	01	H0543_170_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	170	0	1	01	01	H0543_170_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	175	0	1	01	01	H0543_175_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	175	0	1	01	01	H0543_175_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	175	0	1	01	01	H0543_175_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	175	0	1	01	01	H0543_175_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	175	0	1	01	01	H0543_175_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	176	0	1	01	01	H0543_176_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	176	0	1	01	01	H0543_176_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	176	0	1	01	01	H0543_176_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	176	0	1	01	01	H0543_176_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	176	0	1	01	01	H0543_176_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	177	0	1	01	01	H0543_177_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	177	0	1	01	01	H0543_177_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	177	0	1	01	01	H0543_177_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	177	0	1	01	01	H0543_177_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	177	0	1	01	01	H0543_177_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	178	0	1	01	01	H0543_178_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	178	0	1	01	01	H0543_178_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	178	0	1	01	01	H0543_178_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	178	0	1	01	01	H0543_178_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	178	0	1	01	01	H0543_178_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	179	0	1	01	01	H0543_179_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	179	0	1	01	01	H0543_179_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	179	0	1	01	01	H0543_179_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	179	0	1	01	01	H0543_179_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	179	0	1	01	01	H0543_179_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	188	0	1	01	01	H0543_188_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	188	0	1	01	01	H0543_188_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	188	0	1	01	01	H0543_188_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	188	0	1	01	01	H0543_188_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	188	0	1	01	01	H0543_188_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	189	0	1	01	01	H0543_189_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	189	0	1	01	01	H0543_189_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	189	0	1	01	01	H0543_189_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	189	0	1	01	01	H0543_189_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	189	0	1	01	01	H0543_189_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	191	0	1	01	01	H0543_191_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	191	0	1	01	01	H0543_191_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	191	0	1	01	01	H0543_191_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	191	0	1	01	01	H0543_191_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	191	0	1	01	01	H0543_191_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	193	0	1	01	01	H0543_193_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	193	0	1	01	01	H0543_193_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	193	0	1	01	01	H0543_193_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	193	0	1	01	01	H0543_193_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	193	0	1	01	01	H0543_193_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	194	0	1	01	01	H0543_194_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	194	0	1	01	01	H0543_194_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	194	0	1	01	01	H0543_194_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	194	0	1	01	01	H0543_194_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	194	0	1	01	01	H0543_194_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	195	0	1	01	01	H0543_195_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	195	0	1	01	01	H0543_195_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	195	0	1	01	01	H0543_195_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	195	0	1	01	01	H0543_195_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	195	0	1	01	01	H0543_195_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	196	0	1	01	01	H0543_196_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	196	0	1	01	01	H0543_196_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	196	0	1	01	01	H0543_196_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	196	0	1	01	01	H0543_196_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	196	0	1	01	01	H0543_196_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	204	0	1	01	01	H0543_204_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	204	0	1	01	01	H0543_204_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	204	0	1	01	01	H0543_204_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	204	0	1	01	01	H0543_204_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	204	0	1	01	01	H0543_204_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	205	0	1	01	01	H0543_205_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	205	0	1	01	01	H0543_205_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	205	0	1	01	01	H0543_205_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	205	0	1	01	01	H0543_205_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	205	0	1	01	01	H0543_205_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	209	0	1	01	01	H0543_209_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	209	0	1	01	01	H0543_209_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	209	0	1	01	01	H0543_209_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	209	0	1	01	01	H0543_209_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	209	0	1	01	01	H0543_209_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	210	0	1	02	01	H0543_210_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	210	0	1	02	01	H0543_210_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	210	0	1	02	01	H0543_210_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	210	0	1	02	01	H0543_210_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	210	0	1	02	01	H0543_210_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	214	0	1	01	01	H0543_214_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	214	0	1	01	01	H0543_214_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	214	0	1	01	01	H0543_214_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	214	0	1	01	01	H0543_214_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	214	0	1	01	01	H0543_214_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	215	0	1	02	01	H0543_215_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	215	0	1	02	01	H0543_215_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	215	0	1	02	01	H0543_215_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	215	0	1	02	01	H0543_215_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	215	0	1	02	01	H0543_215_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0543	216	0	1	02	01	H0543_216_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0543	216	0	1	02	01	H0543_216_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0543	216	0	1	02	01	H0543_216_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0543	216	0	1	02	01	H0543_216_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0543	216	0	1	02	01	H0543_216_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	002	0	1	01	01	H0544_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	002	0	1	01	01	H0544_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	002	0	1	01	01	H0544_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	002	0	1	01	01	H0544_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	002	0	1	01	01	H0544_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	002	0	1	01	01	H0544_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	003	0	1	01	01	H0544_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0544	003	0	1	01	01	H0544_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	003	0	1	01	01	H0544_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	003	0	1	01	01	H0544_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	003	0	1	01	01	H0544_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	003	0	1	01	01	H0544_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0544	004	0	1	01	01	H0544_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	004	0	1	01	01	H0544_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	004	0	1	01	01	H0544_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	004	0	1	01	01	H0544_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	004	0	1	01	01	H0544_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	004	0	1	01	01	H0544_004_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	005	0	1	01	01	H0544_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	005	0	1	01	01	H0544_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	005	0	1	01	01	H0544_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	005	0	1	01	01	H0544_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	005	0	1	01	01	H0544_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	005	0	1	01	01	H0544_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	007	0	1	01	01	H0544_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	007	0	1	01	01	H0544_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	007	0	1	01	01	H0544_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	007	0	1	01	01	H0544_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	007	0	1	01	01	H0544_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	007	0	1	01	01	H0544_007_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	008	0	1	01	01	H0544_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	008	0	1	01	01	H0544_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	008	0	1	01	01	H0544_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	008	0	1	01	01	H0544_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	008	0	1	01	01	H0544_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	008	0	1	01	01	H0544_008_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	010	0	1	01	01	H0544_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	010	0	1	01	01	H0544_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	010	0	1	01	01	H0544_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	010	0	1	01	01	H0544_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	010	0	1	01	01	H0544_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	010	0	1	01	01	H0544_010_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	013	0	1	01	01	H0544_013_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	013	0	1	01	01	H0544_013_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	013	0	1	01	01	H0544_013_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	013	0	1	01	01	H0544_013_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	013	0	1	01	01	H0544_013_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	013	0	1	01	01	H0544_013_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	014	0	1	01	01	H0544_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	014	0	1	01	01	H0544_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	014	0	1	01	01	H0544_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	014	0	1	01	01	H0544_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	014	0	1	01	01	H0544_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	014	0	1	01	01	H0544_014_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	015	0	1	01	01	H0544_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	015	0	1	01	01	H0544_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	015	0	1	01	01	H0544_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	015	0	1	01	01	H0544_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	015	0	1	01	01	H0544_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	015	0	1	01	01	H0544_015_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	019	0	1	01	01	H0544_019_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	019	0	1	01	01	H0544_019_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	019	0	1	01	01	H0544_019_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	019	0	1	01	01	H0544_019_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	019	0	1	01	01	H0544_019_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	019	0	1	01	01	H0544_019_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	020	0	1	01	01	H0544_020_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	020	0	1	01	01	H0544_020_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	020	0	1	01	01	H0544_020_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	020	0	1	01	01	H0544_020_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	020	0	1	01	01	H0544_020_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	020	0	1	01	01	H0544_020_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	027	0	1	01	01	H0544_027_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	027	0	1	01	01	H0544_027_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	027	0	1	01	01	H0544_027_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	027	0	1	01	01	H0544_027_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	027	0	1	01	01	H0544_027_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	027	0	1	01	01	H0544_027_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	031	0	1	01	01	H0544_031_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	031	0	1	01	01	H0544_031_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	031	0	1	01	01	H0544_031_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	031	0	1	01	01	H0544_031_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	031	0	1	01	01	H0544_031_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	031	0	1	01	01	H0544_031_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	032	0	1	01	01	H0544_032_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	032	0	1	01	01	H0544_032_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	032	0	1	01	01	H0544_032_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	032	0	1	01	01	H0544_032_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	032	0	1	01	01	H0544_032_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	032	0	1	01	01	H0544_032_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	036	0	1	01	01	H0544_036_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	036	0	1	01	01	H0544_036_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	036	0	1	01	01	H0544_036_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	036	0	1	01	01	H0544_036_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	036	0	1	01	01	H0544_036_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	036	0	1	01	01	H0544_036_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	038	0	1	01	01	H0544_038_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	038	0	1	01	01	H0544_038_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	038	0	1	01	01	H0544_038_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	038	0	1	01	01	H0544_038_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	038	0	1	01	01	H0544_038_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	038	0	1	01	01	H0544_038_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	050	0	1	01	01	H0544_050_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	050	0	1	01	01	H0544_050_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	050	0	1	01	01	H0544_050_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	050	0	1	01	01	H0544_050_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	050	0	1	01	01	H0544_050_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	050	0	1	01	01	H0544_050_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	052	0	1	01	01	H0544_052_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H0544	052	0	1	01	01	H0544_052_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	052	0	1	01	01	H0544_052_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	052	0	1	01	01	H0544_052_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	052	0	1	01	01	H0544_052_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	053	0	1	01	01	H0544_053_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H0544	053	0	1	01	01	H0544_053_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	053	0	1	01	01	H0544_053_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	053	0	1	01	01	H0544_053_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	053	0	1	01	01	H0544_053_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	054	0	1	01	01	H0544_054_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H0544	054	0	1	01	01	H0544_054_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	054	0	1	01	01	H0544_054_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	054	0	1	01	01	H0544_054_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	054	0	1	01	01	H0544_054_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	054	0	1	01	01	H0544_054_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0544	055	0	1	01	01	H0544_055_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H0544	055	0	1	01	01	H0544_055_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	055	0	1	01	01	H0544_055_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	055	0	1	01	01	H0544_055_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	055	0	1	01	01	H0544_055_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	056	0	1	01	01	H0544_056_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0544	056	0	1	01	01	H0544_056_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	056	0	1	01	01	H0544_056_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	056	0	1	01	01	H0544_056_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	056	0	1	01	01	H0544_056_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	056	0	1	01	01	H0544_056_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0544	057	0	1	01	01	H0544_057_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	057	0	1	01	01	H0544_057_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	057	0	1	01	01	H0544_057_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	057	0	1	01	01	H0544_057_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	057	0	1	01	01	H0544_057_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	058	0	1	01	01	H0544_058_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	058	0	1	01	01	H0544_058_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	058	0	1	01	01	H0544_058_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	058	0	1	01	01	H0544_058_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	058	0	1	01	01	H0544_058_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	059	0	1	01	01	H0544_059_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	059	0	1	01	01	H0544_059_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	059	0	1	01	01	H0544_059_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	059	0	1	01	01	H0544_059_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	059	0	1	01	01	H0544_059_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	060	3	1	01	01	H0544_060_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0544	060	3	1	01	01	H0544_060_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	060	3	1	01	01	H0544_060_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	060	3	1	01	01	H0544_060_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	060	3	1	01	01	H0544_060_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	060	4	1	01	01	H0544_060_4	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0544	060	4	1	01	01	H0544_060_4	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	060	4	1	01	01	H0544_060_4	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	060	4	1	01	01	H0544_060_4	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	060	4	1	01	01	H0544_060_4	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	061	0	1	01	01	H0544_061_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1	2	0.00				
H0544	061	0	1	01	01	H0544_061_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	061	0	1	01	01	H0544_061_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	061	0	1	01	01	H0544_061_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	061	0	1	01	01	H0544_061_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	062	0	1	01	01	H0544_062_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1	2	0.00				
H0544	062	0	1	01	01	H0544_062_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	062	0	1	01	01	H0544_062_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	062	0	1	01	01	H0544_062_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	062	0	1	01	01	H0544_062_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	063	0	1	01	01	H0544_063_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0544	063	0	1	01	01	H0544_063_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	063	0	1	01	01	H0544_063_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	063	0	1	01	01	H0544_063_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	063	0	1	01	01	H0544_063_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	064	0	1	01	01	H0544_064_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0544	064	0	1	01	01	H0544_064_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	064	0	1	01	01	H0544_064_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	064	0	1	01	01	H0544_064_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	064	0	1	01	01	H0544_064_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	064	0	1	01	01	H0544_064_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0544	065	0	1	01	01	H0544_065_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0544	065	0	1	01	01	H0544_065_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	065	0	1	01	01	H0544_065_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	065	0	1	01	01	H0544_065_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	065	0	1	01	01	H0544_065_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	065	0	1	01	01	H0544_065_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0544	066	0	1	01	01	H0544_066_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	066	0	1	01	01	H0544_066_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	066	0	1	01	01	H0544_066_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	066	0	1	01	01	H0544_066_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	066	0	1	01	01	H0544_066_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	067	0	1	01	01	H0544_067_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	067	0	1	01	01	H0544_067_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	067	0	1	01	01	H0544_067_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	067	0	1	01	01	H0544_067_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	067	0	1	01	01	H0544_067_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	069	0	1	01	01	H0544_069_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	069	0	1	01	01	H0544_069_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	069	0	1	01	01	H0544_069_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	069	0	1	01	01	H0544_069_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	069	0	1	01	01	H0544_069_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	070	0	1	01	01	H0544_070_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1	2	0.00				
H0544	070	0	1	01	01	H0544_070_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	070	0	1	01	01	H0544_070_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	070	0	1	01	01	H0544_070_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	070	0	1	01	01	H0544_070_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	071	0	1	01	01	H0544_071_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	071	0	1	01	01	H0544_071_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	071	0	1	01	01	H0544_071_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	071	0	1	01	01	H0544_071_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	071	0	1	01	01	H0544_071_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	072	0	1	01	01	H0544_072_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	072	0	1	01	01	H0544_072_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	072	0	1	01	01	H0544_072_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	072	0	1	01	01	H0544_072_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	072	0	1	01	01	H0544_072_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	074	0	1	01	01	H0544_074_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0544	074	0	1	01	01	H0544_074_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	074	0	1	01	01	H0544_074_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	074	0	1	01	01	H0544_074_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	074	0	1	01	01	H0544_074_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	074	0	1	01	01	H0544_074_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0544	081	0	1	01	01	H0544_081_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	081	0	1	01	01	H0544_081_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	081	0	1	01	01	H0544_081_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	081	0	1	01	01	H0544_081_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	081	0	1	01	01	H0544_081_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	087	0	1	01	01	H0544_087_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0544	087	0	1	01	01	H0544_087_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	087	0	1	01	01	H0544_087_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	087	0	1	01	01	H0544_087_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	087	0	1	01	01	H0544_087_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	088	0	1	01	01	H0544_088_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0544	088	0	1	01	01	H0544_088_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	088	0	1	01	01	H0544_088_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	088	0	1	01	01	H0544_088_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	088	0	1	01	01	H0544_088_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	089	0	1	01	01	H0544_089_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0544	089	0	1	01	01	H0544_089_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	089	0	1	01	01	H0544_089_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	089	0	1	01	01	H0544_089_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	089	0	1	01	01	H0544_089_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	090	0	1	01	01	H0544_090_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0544	090	0	1	01	01	H0544_090_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0544	090	0	1	01	01	H0544_090_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0544	090	0	1	01	01	H0544_090_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0544	090	0	1	01	01	H0544_090_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0544	091	0	1	01	01	H0544_091_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1	2	0.00				
H0544	091	0	1	01	01	H0544_091_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	091	0	1	01	01	H0544_091_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	091	0	1	01	01	H0544_091_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	091	0	1	01	01	H0544_091_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	093	0	1	01	01	H0544_093_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	093	0	1	01	01	H0544_093_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	093	0	1	01	01	H0544_093_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	093	0	1	01	01	H0544_093_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	093	0	1	01	01	H0544_093_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	093	0	1	01	01	H0544_093_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	094	0	1	01	01	H0544_094_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	094	0	1	01	01	H0544_094_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	094	0	1	01	01	H0544_094_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	094	0	1	01	01	H0544_094_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	094	0	1	01	01	H0544_094_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	094	0	1	01	01	H0544_094_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	095	0	1	01	01	H0544_095_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0544	095	0	1	01	01	H0544_095_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	095	0	1	01	01	H0544_095_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	095	0	1	01	01	H0544_095_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	095	0	1	01	01	H0544_095_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	095	0	1	01	01	H0544_095_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0544	096	0	1	01	01	H0544_096_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1	2	0.00				
H0544	096	0	1	01	01	H0544_096_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	096	0	1	01	01	H0544_096_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	096	0	1	01	01	H0544_096_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	096	0	1	01	01	H0544_096_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	097	0	1	01	01	H0544_097_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1	2	0.00				
H0544	097	0	1	01	01	H0544_097_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	097	0	1	01	01	H0544_097_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	097	0	1	01	01	H0544_097_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	097	0	1	01	01	H0544_097_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	098	0	1	01	01	H0544_098_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1	2	0.00				
H0544	098	0	1	01	01	H0544_098_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	098	0	1	01	01	H0544_098_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	098	0	1	01	01	H0544_098_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	098	0	1	01	01	H0544_098_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	099	0	1	01	01	H0544_099_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	099	0	1	01	01	H0544_099_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	099	0	1	01	01	H0544_099_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	099	0	1	01	01	H0544_099_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	099	0	1	01	01	H0544_099_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	100	0	1	01	01	H0544_100_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H0544	100	0	1	01	01	H0544_100_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	100	0	1	01	01	H0544_100_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	100	0	1	01	01	H0544_100_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	100	0	1	01	01	H0544_100_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	100	0	1	01	01	H0544_100_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0544	101	0	1	01	01	H0544_101_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	101	0	1	01	01	H0544_101_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	101	0	1	01	01	H0544_101_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	101	0	1	01	01	H0544_101_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	101	0	1	01	01	H0544_101_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	101	0	1	01	01	H0544_101_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	102	0	1	01	01	H0544_102_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	102	0	1	01	01	H0544_102_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	102	0	1	01	01	H0544_102_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	102	0	1	01	01	H0544_102_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	102	0	1	01	01	H0544_102_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	102	0	1	01	01	H0544_102_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	103	0	1	01	01	H0544_103_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	103	0	1	01	01	H0544_103_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	103	0	1	01	01	H0544_103_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	103	0	1	01	01	H0544_103_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	103	0	1	01	01	H0544_103_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	103	0	1	01	01	H0544_103_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	104	0	1	01	01	H0544_104_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	104	0	1	01	01	H0544_104_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	104	0	1	01	01	H0544_104_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	104	0	1	01	01	H0544_104_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	104	0	1	01	01	H0544_104_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	104	0	1	01	01	H0544_104_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	105	0	1	01	01	H0544_105_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	105	0	1	01	01	H0544_105_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	105	0	1	01	01	H0544_105_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	105	0	1	01	01	H0544_105_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	105	0	1	01	01	H0544_105_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	105	0	1	01	01	H0544_105_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	106	0	1	01	01	H0544_106_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	106	0	1	01	01	H0544_106_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	106	0	1	01	01	H0544_106_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	106	0	1	01	01	H0544_106_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	106	0	1	01	01	H0544_106_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	106	0	1	01	01	H0544_106_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	107	0	1	01	01	H0544_107_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	107	0	1	01	01	H0544_107_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	107	0	1	01	01	H0544_107_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	107	0	1	01	01	H0544_107_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	107	0	1	01	01	H0544_107_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	107	0	1	01	01	H0544_107_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	108	0	1	01	01	H0544_108_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	108	0	1	01	01	H0544_108_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	108	0	1	01	01	H0544_108_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	108	0	1	01	01	H0544_108_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	108	0	1	01	01	H0544_108_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	110	0	1	01	01	H0544_110_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H0544	110	0	1	01	01	H0544_110_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H0544	110	0	1	01	01	H0544_110_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H0544	110	0	1	01	01	H0544_110_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H0544	110	0	1	01	01	H0544_110_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H0544	117	1	1	01	01	H0544_117_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	117	1	1	01	01	H0544_117_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	117	1	1	01	01	H0544_117_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	117	1	1	01	01	H0544_117_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	117	1	1	01	01	H0544_117_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	117	1	1	01	01	H0544_117_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	117	2	1	01	01	H0544_117_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	117	2	1	01	01	H0544_117_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	117	2	1	01	01	H0544_117_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	117	2	1	01	01	H0544_117_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	117	2	1	01	01	H0544_117_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	117	2	1	01	01	H0544_117_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	118	1	1	01	01	H0544_118_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	118	1	1	01	01	H0544_118_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	118	1	1	01	01	H0544_118_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	118	1	1	01	01	H0544_118_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	118	1	1	01	01	H0544_118_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	118	1	1	01	01	H0544_118_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	118	2	1	01	01	H0544_118_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	118	2	1	01	01	H0544_118_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	118	2	1	01	01	H0544_118_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	118	2	1	01	01	H0544_118_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	118	2	1	01	01	H0544_118_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	118	2	1	01	01	H0544_118_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	119	1	1	01	01	H0544_119_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	119	1	1	01	01	H0544_119_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	119	1	1	01	01	H0544_119_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	119	1	1	01	01	H0544_119_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	119	1	1	01	01	H0544_119_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	119	1	1	01	01	H0544_119_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	119	2	1	01	01	H0544_119_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	119	2	1	01	01	H0544_119_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	119	2	1	01	01	H0544_119_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	119	2	1	01	01	H0544_119_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	119	2	1	01	01	H0544_119_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	119	2	1	01	01	H0544_119_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	120	1	1	01	01	H0544_120_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	120	1	1	01	01	H0544_120_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	120	1	1	01	01	H0544_120_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	120	1	1	01	01	H0544_120_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	120	1	1	01	01	H0544_120_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	120	1	1	01	01	H0544_120_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	120	2	1	01	01	H0544_120_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	120	2	1	01	01	H0544_120_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	120	2	1	01	01	H0544_120_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	120	2	1	01	01	H0544_120_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	120	2	1	01	01	H0544_120_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	120	2	1	01	01	H0544_120_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	121	1	1	01	01	H0544_121_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	121	1	1	01	01	H0544_121_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	121	1	1	01	01	H0544_121_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	121	1	1	01	01	H0544_121_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	121	1	1	01	01	H0544_121_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	121	1	1	01	01	H0544_121_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	121	2	1	01	01	H0544_121_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H0544	121	2	1	01	01	H0544_121_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H0544	121	2	1	01	01	H0544_121_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H0544	121	2	1	01	01	H0544_121_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H0544	121	2	1	01	01	H0544_121_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H0544	121	2	1	01	01	H0544_121_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H0544	122	1	1	01	01	H0544_122_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0544	122	1	1	01	01	H0544_122_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	122	1	1	01	01	H0544_122_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	122	1	1	01	01	H0544_122_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	122	1	1	01	01	H0544_122_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	122	1	1	01	01	H0544_122_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0544	122	2	1	01	01	H0544_122_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0544	122	2	1	01	01	H0544_122_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	122	2	1	01	01	H0544_122_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	122	2	1	01	01	H0544_122_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	122	2	1	01	01	H0544_122_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	122	2	1	01	01	H0544_122_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0544	122	3	1	01	01	H0544_122_3	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0544	122	3	1	01	01	H0544_122_3	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0544	122	3	1	01	01	H0544_122_3	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0544	122	3	1	01	01	H0544_122_3	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0544	122	3	1	01	01	H0544_122_3	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0544	122	3	1	01	01	H0544_122_3	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0545	001	0	1	01	01	H0545_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H0545	001	0	1	01	01	H0545_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	01	3						
H0545	001	0	1	01	01	H0545_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H0545	001	0	1	01	01	H0545_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	3						
H0545	001	0	1	01	01	H0545_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H0545	001	0	1	01	01	H0545_001_0	7	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H0545	012	0	1	01	01	H0545_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H0545	012	0	1	01	01	H0545_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	01	3						
H0545	012	0	1	01	01	H0545_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H0545	012	0	1	01	01	H0545_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	3						
H0545	012	0	1	01	01	H0545_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H0545	012	0	1	01	01	H0545_012_0	3	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H0545	015	0	1	01	01	H0545_015_0	5	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0545	015	0	1	01	01	H0545_015_0	5	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0545	015	0	1	01	01	H0545_015_0	5	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H0545	015	0	1	01	01	H0545_015_0	5	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0545	015	0	1	01	01	H0545_015_0	5	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0562	009	0	1	01	01	H0562_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	009	0	1	01	01	H0562_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	009	0	1	01	01	H0562_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	009	0	1	01	01	H0562_009_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	009	0	1	01	01	H0562_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	009	0	1	01	01	H0562_009_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	012	0	1	01	01	H0562_012_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	012	0	1	01	01	H0562_012_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	012	0	1	01	01	H0562_012_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	012	0	1	01	01	H0562_012_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	012	0	1	01	01	H0562_012_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	012	0	1	01	01	H0562_012_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	039	0	1	01	01	H0562_039_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	039	0	1	01	01	H0562_039_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	039	0	1	01	01	H0562_039_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	039	0	1	01	01	H0562_039_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	039	0	1	01	01	H0562_039_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	039	0	1	01	01	H0562_039_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	055	0	1	01	01	H0562_055_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0562	055	0	1	01	01	H0562_055_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0562	055	0	1	01	01	H0562_055_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0562	055	0	1	01	01	H0562_055_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0562	055	0	1	01	01	H0562_055_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0562	068	0	1	01	01	H0562_068_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	068	0	1	01	01	H0562_068_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	068	0	1	01	01	H0562_068_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	068	0	1	01	01	H0562_068_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	068	0	1	01	01	H0562_068_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	068	0	1	01	01	H0562_068_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	079	0	1	01	01	H0562_079_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	079	0	1	01	01	H0562_079_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	079	0	1	01	01	H0562_079_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	079	0	1	01	01	H0562_079_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	079	0	1	01	01	H0562_079_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	079	0	1	01	01	H0562_079_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	084	0	1	01	01	H0562_084_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	084	0	1	01	01	H0562_084_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	084	0	1	01	01	H0562_084_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	084	0	1	01	01	H0562_084_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	084	0	1	01	01	H0562_084_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	084	0	1	01	01	H0562_084_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	090	0	1	01	01	H0562_090_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H0562	090	0	1	01	01	H0562_090_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	090	0	1	01	01	H0562_090_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	090	0	1	01	01	H0562_090_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	090	0	1	01	01	H0562_090_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	090	0	1	01	01	H0562_090_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	092	0	1	01	01	H0562_092_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	092	0	1	01	01	H0562_092_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	092	0	1	01	01	H0562_092_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	092	0	1	01	01	H0562_092_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	092	0	1	01	01	H0562_092_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	092	0	1	01	01	H0562_092_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	097	0	1	01	01	H0562_097_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H0562	097	0	1	01	01	H0562_097_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	097	0	1	01	01	H0562_097_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	097	0	1	01	01	H0562_097_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	097	0	1	01	01	H0562_097_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	097	0	1	01	01	H0562_097_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	103	0	1	01	01	H0562_103_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H0562	103	0	1	01	01	H0562_103_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	103	0	1	01	01	H0562_103_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	103	0	1	01	01	H0562_103_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	103	0	1	01	01	H0562_103_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	103	0	1	01	01	H0562_103_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	112	0	1	01	01	H0562_112_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	112	0	1	01	01	H0562_112_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	112	0	1	01	01	H0562_112_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	112	0	1	01	01	H0562_112_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	112	0	1	01	01	H0562_112_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	112	0	1	01	01	H0562_112_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	113	0	1	01	01	H0562_113_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	113	0	1	01	01	H0562_113_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	113	0	1	01	01	H0562_113_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	113	0	1	01	01	H0562_113_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	113	0	1	01	01	H0562_113_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	113	0	1	01	01	H0562_113_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	114	0	1	01	01	H0562_114_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	114	0	1	01	01	H0562_114_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	114	0	1	01	01	H0562_114_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	114	0	1	01	01	H0562_114_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	114	0	1	01	01	H0562_114_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	114	0	1	01	01	H0562_114_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	118	0	1	01	01	H0562_118_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	118	0	1	01	01	H0562_118_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	118	0	1	01	01	H0562_118_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	118	0	1	01	01	H0562_118_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	118	0	1	01	01	H0562_118_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	118	0	1	01	01	H0562_118_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	119	0	1	01	01	H0562_119_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	119	0	1	01	01	H0562_119_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	119	0	1	01	01	H0562_119_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	119	0	1	01	01	H0562_119_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	119	0	1	01	01	H0562_119_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	119	0	1	01	01	H0562_119_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	120	0	1	01	01	H0562_120_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	120	0	1	01	01	H0562_120_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	120	0	1	01	01	H0562_120_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	120	0	1	01	01	H0562_120_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	120	0	1	01	01	H0562_120_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	120	0	1	01	01	H0562_120_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	121	0	1	01	01	H0562_121_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0562	121	0	1	01	01	H0562_121_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0562	121	0	1	01	01	H0562_121_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0562	121	0	1	01	01	H0562_121_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0562	121	0	1	01	01	H0562_121_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0562	122	0	1	01	01	H0562_122_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	122	0	1	01	01	H0562_122_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	122	0	1	01	01	H0562_122_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	122	0	1	01	01	H0562_122_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	122	0	1	01	01	H0562_122_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	122	0	1	01	01	H0562_122_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	123	0	1	01	01	H0562_123_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	123	0	1	01	01	H0562_123_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	123	0	1	01	01	H0562_123_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	123	0	1	01	01	H0562_123_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	123	0	1	01	01	H0562_123_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	123	0	1	01	01	H0562_123_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	124	0	1	01	01	H0562_124_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0562	124	0	1	01	01	H0562_124_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	124	0	1	01	01	H0562_124_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	124	0	1	01	01	H0562_124_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	124	0	1	01	01	H0562_124_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	124	0	1	01	01	H0562_124_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	125	0	1	01	01	H0562_125_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H0562	125	0	1	01	01	H0562_125_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	125	0	1	01	01	H0562_125_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	125	0	1	01	01	H0562_125_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	125	0	1	01	01	H0562_125_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	125	0	1	01	01	H0562_125_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0562	126	0	1	01	01	H0562_126_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H0562	126	0	1	01	01	H0562_126_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0562	126	0	1	01	01	H0562_126_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0562	126	0	1	01	01	H0562_126_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0562	126	0	1	01	01	H0562_126_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0562	126	0	1	01	01	H0562_126_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0571	001	0	1	01	01	H0571_001_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H0571	001	0	1	01	01	H0571_001_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H0571	001	0	1	01	01	H0571_001_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H0571	001	0	1	01	01	H0571_001_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H0571	001	0	1	01	01	H0571_001_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H0571	007	0	1	01	01	H0571_007_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H0571	007	0	1	01	01	H0571_007_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H0571	007	0	1	01	01	H0571_007_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H0571	007	0	1	01	01	H0571_007_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H0571	007	0	1	01	01	H0571_007_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H0609	007	0	1	01	01	H0609_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	007	0	1	01	01	H0609_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	007	0	1	01	01	H0609_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	007	0	1	01	01	H0609_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	007	0	1	01	01	H0609_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	012	0	1	01	01	H0609_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	012	0	1	01	01	H0609_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	012	0	1	01	01	H0609_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	012	0	1	01	01	H0609_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	012	0	1	01	01	H0609_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	025	0	1	01	01	H0609_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	025	0	1	01	01	H0609_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	025	0	1	01	01	H0609_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	025	0	1	01	01	H0609_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	025	0	1	01	01	H0609_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	026	0	1	01	01	H0609_026_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	026	0	1	01	01	H0609_026_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	026	0	1	01	01	H0609_026_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	026	0	1	01	01	H0609_026_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	026	0	1	01	01	H0609_026_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	027	0	1	01	01	H0609_027_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	027	0	1	01	01	H0609_027_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	027	0	1	01	01	H0609_027_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	027	0	1	01	01	H0609_027_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	027	0	1	01	01	H0609_027_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	028	0	1	01	01	H0609_028_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	028	0	1	01	01	H0609_028_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	028	0	1	01	01	H0609_028_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	028	0	1	01	01	H0609_028_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	028	0	1	01	01	H0609_028_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	031	0	1	01	01	H0609_031_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	031	0	1	01	01	H0609_031_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	031	0	1	01	01	H0609_031_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	031	0	1	01	01	H0609_031_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	031	0	1	01	01	H0609_031_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	032	0	1	01	01	H0609_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	032	0	1	01	01	H0609_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	032	0	1	01	01	H0609_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	032	0	1	01	01	H0609_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	032	0	1	01	01	H0609_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	033	0	1	01	01	H0609_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	033	0	1	01	01	H0609_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	033	0	1	01	01	H0609_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	033	0	1	01	01	H0609_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	033	0	1	01	01	H0609_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	034	1	1	01	01	H0609_034_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	034	1	1	01	01	H0609_034_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	034	1	1	01	01	H0609_034_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	034	1	1	01	01	H0609_034_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	034	1	1	01	01	H0609_034_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	034	2	1	01	01	H0609_034_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	034	2	1	01	01	H0609_034_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	034	2	1	01	01	H0609_034_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	034	2	1	01	01	H0609_034_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	034	2	1	01	01	H0609_034_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	036	1	1	01	01	H0609_036_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	036	1	1	01	01	H0609_036_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	036	1	1	01	01	H0609_036_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	036	1	1	01	01	H0609_036_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	036	1	1	01	01	H0609_036_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	036	2	1	01	01	H0609_036_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	036	2	1	01	01	H0609_036_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	036	2	1	01	01	H0609_036_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	036	2	1	01	01	H0609_036_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	036	2	1	01	01	H0609_036_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	037	0	1	01	01	H0609_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	037	0	1	01	01	H0609_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	037	0	1	01	01	H0609_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	037	0	1	01	01	H0609_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	037	0	1	01	01	H0609_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	038	0	1	01	01	H0609_038_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	038	0	1	01	01	H0609_038_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	038	0	1	01	01	H0609_038_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	038	0	1	01	01	H0609_038_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	038	0	1	01	01	H0609_038_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0609	040	0	1	01	01	H0609_040_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0609	040	0	1	01	01	H0609_040_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0609	040	0	1	01	01	H0609_040_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0609	040	0	1	01	01	H0609_040_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0609	040	0	1	01	01	H0609_040_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	001	0	1	01	01	H0628_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	001	0	1	01	01	H0628_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	001	0	1	01	01	H0628_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	001	0	1	01	01	H0628_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	001	0	1	01	01	H0628_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	003	0	1	01	01	H0628_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	003	0	1	01	01	H0628_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	003	0	1	01	01	H0628_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	003	0	1	01	01	H0628_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	003	0	1	01	01	H0628_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	005	0	1	01	01	H0628_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	005	0	1	01	01	H0628_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	005	0	1	01	01	H0628_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	005	0	1	01	01	H0628_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	005	0	1	01	01	H0628_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	006	0	1	01	01	H0628_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	006	0	1	01	01	H0628_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	006	0	1	01	01	H0628_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	006	0	1	01	01	H0628_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	006	0	1	01	01	H0628_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	007	0	1	01	01	H0628_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	007	0	1	01	01	H0628_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	007	0	1	01	01	H0628_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	007	0	1	01	01	H0628_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	007	0	1	01	01	H0628_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	008	0	1	01	01	H0628_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	008	0	1	01	01	H0628_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	008	0	1	01	01	H0628_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	008	0	1	01	01	H0628_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	008	0	1	01	01	H0628_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	009	0	1	01	01	H0628_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	009	0	1	01	01	H0628_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	009	0	1	01	01	H0628_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	009	0	1	01	01	H0628_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	009	0	1	01	01	H0628_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	010	0	1	01	01	H0628_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	010	0	1	01	01	H0628_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	010	0	1	01	01	H0628_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	010	0	1	01	01	H0628_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	010	0	1	01	01	H0628_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	011	0	1	01	01	H0628_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	011	0	1	01	01	H0628_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	011	0	1	01	01	H0628_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	011	0	1	01	01	H0628_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	011	0	1	01	01	H0628_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	012	0	1	01	01	H0628_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	012	0	1	01	01	H0628_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	012	0	1	01	01	H0628_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	012	0	1	01	01	H0628_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	012	0	1	01	01	H0628_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	013	0	1	01	01	H0628_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	013	0	1	01	01	H0628_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	013	0	1	01	01	H0628_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	013	0	1	01	01	H0628_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	013	0	1	01	01	H0628_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0628	017	0	1	01	01	H0628_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0628	017	0	1	01	01	H0628_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0628	017	0	1	01	01	H0628_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0628	017	0	1	01	01	H0628_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0628	017	0	1	01	01	H0628_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0630	013	0	1	01	01	H0630_013_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H0630	013	0	1	01	01	H0630_013_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H0630	013	0	1	01	01	H0630_013_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H0630	013	0	1	01	01	H0630_013_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H0630	013	0	1	01	01	H0630_013_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H0630	013	0	1	01	01	H0630_013_0	10	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H0630	015	0	1	01	01	H0630_015_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H0630	015	0	1	01	01	H0630_015_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H0630	015	0	1	01	01	H0630_015_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H0630	015	0	1	01	01	H0630_015_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H0630	015	0	1	01	01	H0630_015_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H0630	015	0	1	01	01	H0630_015_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H0630	016	0	1	01	01	H0630_016_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H0630	016	0	1	01	01	H0630_016_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H0630	016	0	1	01	01	H0630_016_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H0630	016	0	1	01	01	H0630_016_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H0630	016	0	1	01	01	H0630_016_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H0630	016	0	1	01	01	H0630_016_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H0630	017	0	1	01	01	H0630_017_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H0630	017	0	1	01	01	H0630_017_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H0630	017	0	1	01	01	H0630_017_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H0630	017	0	1	01	01	H0630_017_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H0630	017	0	1	01	01	H0630_017_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H0630	017	0	1	01	01	H0630_017_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H0630	020	0	1	01	01	H0630_020_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H0630	020	0	1	01	01	H0630_020_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H0630	020	0	1	01	01	H0630_020_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H0630	020	0	1	01	01	H0630_020_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H0630	020	0	1	01	01	H0630_020_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H0630	020	0	1	01	01	H0630_020_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H0630	021	0	1	01	01	H0630_021_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H0630	021	0	1	01	01	H0630_021_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H0630	021	0	1	01	01	H0630_021_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H0630	021	0	1	01	01	H0630_021_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H0630	021	0	1	01	01	H0630_021_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H0630	021	0	1	01	01	H0630_021_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H0630	023	0	1	01	01	H0630_023_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H0630	023	0	1	01	01	H0630_023_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H0630	023	0	1	01	01	H0630_023_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H0630	023	0	1	01	01	H0630_023_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H0630	023	0	1	01	01	H0630_023_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H0630	023	0	1	01	01	H0630_023_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H0672	001	0	1	01	01	H0672_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0672	001	0	1	01	01	H0672_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0672	001	0	1	01	01	H0672_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0672	001	0	1	01	01	H0672_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0672	001	0	1	01	01	H0672_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0672	002	0	1	01	01	H0672_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0672	002	0	1	01	01	H0672_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0672	002	0	1	01	01	H0672_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0672	002	0	1	01	01	H0672_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0672	002	0	1	01	01	H0672_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0672	003	0	1	01	01	H0672_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0672	003	0	1	01	01	H0672_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0672	003	0	1	01	01	H0672_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0672	003	0	1	01	01	H0672_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0672	003	0	1	01	01	H0672_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0672	004	0	1	01	01	H0672_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0672	004	0	1	01	01	H0672_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0672	004	0	1	01	01	H0672_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0672	004	0	1	01	01	H0672_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0672	004	0	1	01	01	H0672_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0672	005	0	1	01	01	H0672_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0672	005	0	1	01	01	H0672_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0672	005	0	1	01	01	H0672_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0672	005	0	1	01	01	H0672_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0672	005	0	1	01	01	H0672_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0672	006	0	1	01	01	H0672_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0672	006	0	1	01	01	H0672_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0672	006	0	1	01	01	H0672_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0672	006	0	1	01	01	H0672_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0672	006	0	1	01	01	H0672_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0710	008	0	1	04	01	H0710_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0710	008	0	1	04	01	H0710_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0710	008	0	1	04	01	H0710_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0710	008	0	1	04	01	H0710_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0710	008	0	1	04	01	H0710_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0710	009	0	1	04	01	H0710_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0710	009	0	1	04	01	H0710_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0710	009	0	1	04	01	H0710_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0710	009	0	1	04	01	H0710_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0710	009	0	1	04	01	H0710_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0710	012	0	1	04	01	H0710_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0710	012	0	1	04	01	H0710_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0710	012	0	1	04	01	H0710_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0710	012	0	1	04	01	H0710_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0710	012	0	1	04	01	H0710_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0710	030	0	1	04	01	H0710_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0710	030	0	1	04	01	H0710_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0710	030	0	1	04	01	H0710_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0710	030	0	1	04	01	H0710_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0710	030	0	1	04	01	H0710_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0710	037	0	1	04	01	H0710_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0710	037	0	1	04	01	H0710_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0710	037	0	1	04	01	H0710_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0710	037	0	1	04	01	H0710_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0710	037	0	1	04	01	H0710_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0710	042	0	1	04	01	H0710_042_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0710	042	0	1	04	01	H0710_042_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0710	042	0	1	04	01	H0710_042_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0710	042	0	1	04	01	H0710_042_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0710	042	0	1	04	01	H0710_042_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0710	047	0	1	04	01	H0710_047_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0710	047	0	1	04	01	H0710_047_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0710	047	0	1	04	01	H0710_047_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0710	047	0	1	04	01	H0710_047_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0710	047	0	1	04	01	H0710_047_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0710	049	0	1	04	01	H0710_049_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0710	049	0	1	04	01	H0710_049_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0710	049	0	1	04	01	H0710_049_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0710	049	0	1	04	01	H0710_049_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0710	049	0	1	04	01	H0710_049_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0710	050	0	1	04	01	H0710_050_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0710	050	0	1	04	01	H0710_050_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0710	050	0	1	04	01	H0710_050_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0710	050	0	1	04	01	H0710_050_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0710	050	0	1	04	01	H0710_050_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0712	005	0	1	01	01	H0712_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0712	005	0	1	01	01	H0712_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0712	005	0	1	01	01	H0712_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0712	005	0	1	01	01	H0712_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0712	005	0	1	01	01	H0712_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0712	019	0	1	01	01	H0712_019_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0712	019	0	1	01	01	H0712_019_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0712	019	0	1	01	01	H0712_019_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0712	019	0	1	01	01	H0712_019_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0712	019	0	1	01	01	H0712_019_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0712	020	0	1	01	01	H0712_020_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0712	020	0	1	01	01	H0712_020_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0712	020	0	1	01	01	H0712_020_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0712	020	0	1	01	01	H0712_020_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0712	020	0	1	01	01	H0712_020_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0712	022	0	1	01	01	H0712_022_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0712	022	0	1	01	01	H0712_022_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0712	022	0	1	01	01	H0712_022_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0712	022	0	1	01	01	H0712_022_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0712	022	0	1	01	01	H0712_022_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0712	023	0	1	01	01	H0712_023_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0712	023	0	1	01	01	H0712_023_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0712	023	0	1	01	01	H0712_023_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0712	023	0	1	01	01	H0712_023_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0712	023	0	1	01	01	H0712_023_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0712	025	0	1	01	01	H0712_025_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0712	025	0	1	01	01	H0712_025_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0712	025	0	1	01	01	H0712_025_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0712	025	0	1	01	01	H0712_025_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0712	025	0	1	01	01	H0712_025_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0712	029	0	1	01	01	H0712_029_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0712	029	0	1	01	01	H0712_029_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0712	029	0	1	01	01	H0712_029_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0712	029	0	1	01	01	H0712_029_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0712	029	0	1	01	01	H0712_029_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0724	001	0	1	01	01	H0724_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0724	001	0	1	01	01	H0724_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0724	001	0	1	01	01	H0724_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0724	001	0	1	01	01	H0724_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0724	001	0	1	01	01	H0724_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0724	001	0	1	01	01	H0724_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0724	006	0	1	01	01	H0724_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0724	006	0	1	01	01	H0724_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0724	006	0	1	01	01	H0724_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0724	006	0	1	01	01	H0724_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0724	006	0	1	01	01	H0724_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0724	007	0	1	01	01	H0724_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0724	007	0	1	01	01	H0724_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0724	007	0	1	01	01	H0724_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0724	007	0	1	01	01	H0724_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0724	007	0	1	01	01	H0724_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0724	007	0	1	01	01	H0724_007_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H0755	030	0	1	01	01	H0755_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	030	0	1	01	01	H0755_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	030	0	1	01	01	H0755_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	030	0	1	01	01	H0755_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	030	0	1	01	01	H0755_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0755	031	0	1	01	01	H0755_031_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	031	0	1	01	01	H0755_031_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	031	0	1	01	01	H0755_031_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	031	0	1	01	01	H0755_031_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	031	0	1	01	01	H0755_031_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0755	033	0	1	01	01	H0755_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	033	0	1	01	01	H0755_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	033	0	1	01	01	H0755_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	033	0	1	01	01	H0755_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	033	0	1	01	01	H0755_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0755	038	0	1	01	01	H0755_038_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	038	0	1	01	01	H0755_038_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	038	0	1	01	01	H0755_038_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	038	0	1	01	01	H0755_038_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	038	0	1	01	01	H0755_038_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0755	040	1	1	01	01	H0755_040_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	040	1	1	01	01	H0755_040_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	040	1	1	01	01	H0755_040_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	040	1	1	01	01	H0755_040_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	040	1	1	01	01	H0755_040_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0755	040	2	1	01	01	H0755_040_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	040	2	1	01	01	H0755_040_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	040	2	1	01	01	H0755_040_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	040	2	1	01	01	H0755_040_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	040	2	1	01	01	H0755_040_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0755	041	1	1	01	01	H0755_041_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	041	1	1	01	01	H0755_041_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	041	1	1	01	01	H0755_041_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	041	1	1	01	01	H0755_041_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	041	1	1	01	01	H0755_041_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0755	041	2	1	01	01	H0755_041_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	041	2	1	01	01	H0755_041_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	041	2	1	01	01	H0755_041_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	041	2	1	01	01	H0755_041_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	041	2	1	01	01	H0755_041_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0755	042	1	1	01	01	H0755_042_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	042	1	1	01	01	H0755_042_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	042	1	1	01	01	H0755_042_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	042	1	1	01	01	H0755_042_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	042	1	1	01	01	H0755_042_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0755	042	2	1	01	01	H0755_042_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0755	042	2	1	01	01	H0755_042_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H0755	042	2	1	01	01	H0755_042_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0755	042	2	1	01	01	H0755_042_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0755	042	2	1	01	01	H0755_042_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0783	001	0	1	01	01	H0783_001_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H0783	001	0	1	01	01	H0783_001_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0783	001	0	1	01	01	H0783_001_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0783	001	0	1	01	01	H0783_001_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0783	001	0	1	01	01	H0783_001_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0798	001	0	1	01	01	H0798_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0798	001	0	1	01	01	H0798_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0798	001	0	1	01	01	H0798_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0798	001	0	1	01	01	H0798_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0798	001	0	1	01	01	H0798_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0838	020	0	1	01	01	H0838_020_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	020	0	1	01	01	H0838_020_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	020	0	1	01	01	H0838_020_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	020	0	1	01	01	H0838_020_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	020	0	1	01	01	H0838_020_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	020	0	1	01	01	H0838_020_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	024	0	1	01	01	H0838_024_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	024	0	1	01	01	H0838_024_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	024	0	1	01	01	H0838_024_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	024	0	1	01	01	H0838_024_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	024	0	1	01	01	H0838_024_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	024	0	1	01	01	H0838_024_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	025	0	1	01	01	H0838_025_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	025	0	1	01	01	H0838_025_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	025	0	1	01	01	H0838_025_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	025	0	1	01	01	H0838_025_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	025	0	1	01	01	H0838_025_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	025	0	1	01	01	H0838_025_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	028	0	1	01	01	H0838_028_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	028	0	1	01	01	H0838_028_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	028	0	1	01	01	H0838_028_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	028	0	1	01	01	H0838_028_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	028	0	1	01	01	H0838_028_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	028	0	1	01	01	H0838_028_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	029	0	1	01	01	H0838_029_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	029	0	1	01	01	H0838_029_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	029	0	1	01	01	H0838_029_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	029	0	1	01	01	H0838_029_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	029	0	1	01	01	H0838_029_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	029	0	1	01	01	H0838_029_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	032	0	1	01	01	H0838_032_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	032	0	1	01	01	H0838_032_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H0838	032	0	1	01	01	H0838_032_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	032	0	1	01	01	H0838_032_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	032	0	1	01	01	H0838_032_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	032	0	1	01	01	H0838_032_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	033	0	1	01	01	H0838_033_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	033	0	1	01	01	H0838_033_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	033	0	1	01	01	H0838_033_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	033	0	1	01	01	H0838_033_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	033	0	1	01	01	H0838_033_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	033	0	1	01	01	H0838_033_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	037	0	1	01	01	H0838_037_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	037	0	1	01	01	H0838_037_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	037	0	1	01	01	H0838_037_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	037	0	1	01	01	H0838_037_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	037	0	1	01	01	H0838_037_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	037	0	1	01	01	H0838_037_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	039	1	1	01	01	H0838_039_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	039	1	1	01	01	H0838_039_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	039	1	1	01	01	H0838_039_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	039	1	1	01	01	H0838_039_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	039	1	1	01	01	H0838_039_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	039	1	1	01	01	H0838_039_1	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	039	2	1	01	01	H0838_039_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	039	2	1	01	01	H0838_039_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	039	2	1	01	01	H0838_039_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	039	2	1	01	01	H0838_039_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	039	2	1	01	01	H0838_039_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	039	2	1	01	01	H0838_039_2	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	040	1	1	01	01	H0838_040_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	040	1	1	01	01	H0838_040_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	040	1	1	01	01	H0838_040_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	040	1	1	01	01	H0838_040_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	040	1	1	01	01	H0838_040_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	040	1	1	01	01	H0838_040_1	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	040	2	1	01	01	H0838_040_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	040	2	1	01	01	H0838_040_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	040	2	1	01	01	H0838_040_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	040	2	1	01	01	H0838_040_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	040	2	1	01	01	H0838_040_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	040	2	1	01	01	H0838_040_2	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	042	0	1	01	01	H0838_042_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	042	0	1	01	01	H0838_042_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	042	0	1	01	01	H0838_042_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	042	0	1	01	01	H0838_042_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	042	0	1	01	01	H0838_042_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	042	0	1	01	01	H0838_042_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	043	0	1	01	01	H0838_043_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	043	0	1	01	01	H0838_043_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	043	0	1	01	01	H0838_043_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	043	0	1	01	01	H0838_043_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	043	0	1	01	01	H0838_043_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	043	0	1	01	01	H0838_043_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	044	0	1	01	01	H0838_044_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	044	0	1	01	01	H0838_044_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	044	0	1	01	01	H0838_044_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	044	0	1	01	01	H0838_044_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	044	0	1	01	01	H0838_044_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	044	0	1	01	01	H0838_044_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0838	045	0	1	01	01	H0838_045_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0838	045	0	1	01	01	H0838_045_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H0838	045	0	1	01	01	H0838_045_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H0838	045	0	1	01	01	H0838_045_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H0838	045	0	1	01	01	H0838_045_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H0838	045	0	1	01	01	H0838_045_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H0885	001	0	1	04	01	H0885_001_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0885	001	0	1	04	01	H0885_001_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0885	001	0	1	04	01	H0885_001_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0885	001	0	1	04	01	H0885_001_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0885	001	0	1	04	01	H0885_001_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0885	002	0	1	04	01	H0885_002_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0885	002	0	1	04	01	H0885_002_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0885	002	0	1	04	01	H0885_002_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0885	002	0	1	04	01	H0885_002_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0885	002	0	1	04	01	H0885_002_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0907	001	0	1	01	01	H0907_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H0907	001	0	1	01	01	H0907_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H0907	001	0	1	01	01	H0907_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H0907	001	0	1	01	01	H0907_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H0907	001	0	1	01	01	H0907_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H0907	001	0	1	01	01	H0907_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H0908	001	0	1	01	01	H0908_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H0908	001	0	1	01	01	H0908_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H0908	001	0	1	01	01	H0908_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0908	001	0	1	01	01	H0908_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0908	001	0	1	01	01	H0908_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0913	002	0	1	02	01	H0913_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0913	002	0	1	02	01	H0913_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0913	002	0	1	02	01	H0913_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0913	002	0	1	02	01	H0913_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0913	002	0	1	02	01	H0913_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0913	013	0	1	01	01	H0913_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0913	013	0	1	01	01	H0913_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0913	013	0	1	01	01	H0913_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0913	013	0	1	01	01	H0913_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0913	013	0	1	01	01	H0913_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0913	015	0	1	01	01	H0913_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0913	015	0	1	01	01	H0913_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0913	015	0	1	01	01	H0913_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0913	015	0	1	01	01	H0913_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0913	015	0	1	01	01	H0913_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0913	017	0	1	01	01	H0913_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0913	017	0	1	01	01	H0913_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0913	017	0	1	01	01	H0913_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0913	017	0	1	01	01	H0913_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0913	017	0	1	01	01	H0913_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0927	001	0	1	48	05	H0927_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	1	2	11					1	0.00	0.00
H0927	001	0	1	48	05	H0927_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	2	2	11					1	0.00	0.00
H0927	001	0	1	48	05	H0927_001_0	3	Non-Medicare OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	3	2	11					2	0.00	0.00
H0969	001	0	1	04	01	H0969_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0969	001	0	1	04	01	H0969_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0969	001	0	1	04	01	H0969_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0969	001	0	1	04	01	H0969_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0969	001	0	1	04	01	H0969_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0969	002	0	1	04	01	H0969_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H0969	002	0	1	04	01	H0969_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H0969	002	0	1	04	01	H0969_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H0969	002	0	1	04	01	H0969_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H0969	002	0	1	04	01	H0969_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H0982	001	0	1	01	01	H0982_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	001	0	1	01	01	H0982_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	001	0	1	01	01	H0982_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	001	0	1	01	01	H0982_001_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	001	0	1	01	01	H0982_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	001	0	1	01	01	H0982_001_0	6	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	002	0	1	01	01	H0982_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	002	0	1	01	01	H0982_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	002	0	1	01	01	H0982_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	002	0	1	01	01	H0982_002_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	002	0	1	01	01	H0982_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	002	0	1	01	01	H0982_002_0	7	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	005	0	1	01	01	H0982_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	005	0	1	01	01	H0982_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	005	0	1	01	01	H0982_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	005	0	1	01	01	H0982_005_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	005	0	1	01	01	H0982_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	005	0	1	01	01	H0982_005_0	6	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	006	0	1	01	01	H0982_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	006	0	1	01	01	H0982_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	006	0	1	01	01	H0982_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	006	0	1	01	01	H0982_006_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	006	0	1	01	01	H0982_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	006	0	1	01	01	H0982_006_0	7	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	007	0	1	01	01	H0982_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	007	0	1	01	01	H0982_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	007	0	1	01	01	H0982_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	007	0	1	01	01	H0982_007_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	007	0	1	01	01	H0982_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	007	0	1	01	01	H0982_007_0	6	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	008	0	1	01	01	H0982_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	008	0	1	01	01	H0982_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	008	0	1	01	01	H0982_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	008	0	1	01	01	H0982_008_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	008	0	1	01	01	H0982_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	008	0	1	01	01	H0982_008_0	6	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	009	0	1	01	01	H0982_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	009	0	1	01	01	H0982_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	009	0	1	01	01	H0982_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	009	0	1	01	01	H0982_009_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	009	0	1	01	01	H0982_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	009	0	1	01	01	H0982_009_0	6	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	010	0	1	01	01	H0982_010_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	010	0	1	01	01	H0982_010_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	010	0	1	01	01	H0982_010_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	010	0	1	01	01	H0982_010_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	010	0	1	01	01	H0982_010_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	010	0	1	01	01	H0982_010_0	7	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	011	0	1	01	01	H0982_011_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	011	0	1	01	01	H0982_011_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	011	0	1	01	01	H0982_011_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	011	0	1	01	01	H0982_011_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	011	0	1	01	01	H0982_011_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	011	0	1	01	01	H0982_011_0	7	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	012	0	1	01	01	H0982_012_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	012	0	1	01	01	H0982_012_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	012	0	1	01	01	H0982_012_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	012	0	1	01	01	H0982_012_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	012	0	1	01	01	H0982_012_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	012	0	1	01	01	H0982_012_0	7	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H0982	013	0	1	01	01	H0982_013_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H0982	013	0	1	01	01	H0982_013_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H0982	013	0	1	01	01	H0982_013_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H0982	013	0	1	01	01	H0982_013_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H0982	013	0	1	01	01	H0982_013_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	10	1						
H0982	013	0	1	01	01	H0982_013_0	7	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H1016	001	0	1	01	01	H1016_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1016	001	0	1	01	01	H1016_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1016	001	0	1	01	01	H1016_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H1016	001	0	1	01	01	H1016_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H1016	001	0	1	01	01	H1016_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1016	021	0	1	01	01	H1016_021_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1016	021	0	1	01	01	H1016_021_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1016	021	0	1	01	01	H1016_021_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H1016	021	0	1	01	01	H1016_021_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H1016	021	0	1	01	01	H1016_021_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1016	023	0	1	01	01	H1016_023_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1016	023	0	1	01	01	H1016_023_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1016	023	0	1	01	01	H1016_023_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H1016	023	0	1	01	01	H1016_023_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H1016	023	0	1	01	01	H1016_023_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1016	024	0	1	01	01	H1016_024_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1016	024	0	1	01	01	H1016_024_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1016	024	0	1	01	01	H1016_024_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H1016	024	0	1	01	01	H1016_024_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H1016	024	0	1	01	01	H1016_024_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1016	025	0	1	02	01	H1016_025_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1016	025	0	1	02	01	H1016_025_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1016	025	0	1	02	01	H1016_025_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H1016	025	0	1	02	01	H1016_025_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H1016	025	0	1	02	01	H1016_025_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1016	026	0	1	02	01	H1016_026_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1016	026	0	1	02	01	H1016_026_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1016	026	0	1	02	01	H1016_026_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H1016	026	0	1	02	01	H1016_026_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H1016	026	0	1	02	01	H1016_026_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1016	028	0	1	01	01	H1016_028_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1016	028	0	1	01	01	H1016_028_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1016	028	0	1	01	01	H1016_028_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H1016	028	0	1	01	01	H1016_028_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H1016	028	0	1	01	01	H1016_028_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	001	0	1	01	01	H1019_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	001	0	1	01	01	H1019_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	001	0	1	01	01	H1019_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	001	0	1	01	01	H1019_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	001	0	1	01	01	H1019_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	006	0	1	01	01	H1019_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	006	0	1	01	01	H1019_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	006	0	1	01	01	H1019_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	006	0	1	01	01	H1019_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	006	0	1	01	01	H1019_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	023	0	1	01	01	H1019_023_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	023	0	1	01	01	H1019_023_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	023	0	1	01	01	H1019_023_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	023	0	1	01	01	H1019_023_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	023	0	1	01	01	H1019_023_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	026	0	1	01	01	H1019_026_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	026	0	1	01	01	H1019_026_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	026	0	1	01	01	H1019_026_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	026	0	1	01	01	H1019_026_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	026	0	1	01	01	H1019_026_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	043	0	1	01	01	H1019_043_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	043	0	1	01	01	H1019_043_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	043	0	1	01	01	H1019_043_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	043	0	1	01	01	H1019_043_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	043	0	1	01	01	H1019_043_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	057	0	1	02	01	H1019_057_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	057	0	1	02	01	H1019_057_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	057	0	1	02	01	H1019_057_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	057	0	1	02	01	H1019_057_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	057	0	1	02	01	H1019_057_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	065	0	1	01	01	H1019_065_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	065	0	1	01	01	H1019_065_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	065	0	1	01	01	H1019_065_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	065	0	1	01	01	H1019_065_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	065	0	1	01	01	H1019_065_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	069	0	1	01	01	H1019_069_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	069	0	1	01	01	H1019_069_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	069	0	1	01	01	H1019_069_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	069	0	1	01	01	H1019_069_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	069	0	1	01	01	H1019_069_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	073	0	1	01	01	H1019_073_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	073	0	1	01	01	H1019_073_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	073	0	1	01	01	H1019_073_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	073	0	1	01	01	H1019_073_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	073	0	1	01	01	H1019_073_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	076	0	1	01	01	H1019_076_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	076	0	1	01	01	H1019_076_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	076	0	1	01	01	H1019_076_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	076	0	1	01	01	H1019_076_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	076	0	1	01	01	H1019_076_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	089	0	1	01	01	H1019_089_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	089	0	1	01	01	H1019_089_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	089	0	1	01	01	H1019_089_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	089	0	1	01	01	H1019_089_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	089	0	1	01	01	H1019_089_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	092	0	1	01	01	H1019_092_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	092	0	1	01	01	H1019_092_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	092	0	1	01	01	H1019_092_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	092	0	1	01	01	H1019_092_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	092	0	1	01	01	H1019_092_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	094	0	1	01	01	H1019_094_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	094	0	1	01	01	H1019_094_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	094	0	1	01	01	H1019_094_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	094	0	1	01	01	H1019_094_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	094	0	1	01	01	H1019_094_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	098	0	1	01	01	H1019_098_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	098	0	1	01	01	H1019_098_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	098	0	1	01	01	H1019_098_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	098	0	1	01	01	H1019_098_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	098	0	1	01	01	H1019_098_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	099	0	1	01	01	H1019_099_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	099	0	1	01	01	H1019_099_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	099	0	1	01	01	H1019_099_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	099	0	1	01	01	H1019_099_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	099	0	1	01	01	H1019_099_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	102	0	1	01	01	H1019_102_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	102	0	1	01	01	H1019_102_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	102	0	1	01	01	H1019_102_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	102	0	1	01	01	H1019_102_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	102	0	1	01	01	H1019_102_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	103	1	1	01	01	H1019_103_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	103	1	1	01	01	H1019_103_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	103	1	1	01	01	H1019_103_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	103	1	1	01	01	H1019_103_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	103	1	1	01	01	H1019_103_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	103	2	1	01	01	H1019_103_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	103	2	1	01	01	H1019_103_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	103	2	1	01	01	H1019_103_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	103	2	1	01	01	H1019_103_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	103	2	1	01	01	H1019_103_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	104	1	1	01	01	H1019_104_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	104	1	1	01	01	H1019_104_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	104	1	1	01	01	H1019_104_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	104	1	1	01	01	H1019_104_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	104	1	1	01	01	H1019_104_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	104	2	1	01	01	H1019_104_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	104	2	1	01	01	H1019_104_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	104	2	1	01	01	H1019_104_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	104	2	1	01	01	H1019_104_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	104	2	1	01	01	H1019_104_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	105	0	1	01	01	H1019_105_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	105	0	1	01	01	H1019_105_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	105	0	1	01	01	H1019_105_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	105	0	1	01	01	H1019_105_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	105	0	1	01	01	H1019_105_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	106	0	1	01	01	H1019_106_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	106	0	1	01	01	H1019_106_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	106	0	1	01	01	H1019_106_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	106	0	1	01	01	H1019_106_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	106	0	1	01	01	H1019_106_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	107	0	1	01	01	H1019_107_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	107	0	1	01	01	H1019_107_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	107	0	1	01	01	H1019_107_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	107	0	1	01	01	H1019_107_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	107	0	1	01	01	H1019_107_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	108	0	1	01	01	H1019_108_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	108	0	1	01	01	H1019_108_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	108	0	1	01	01	H1019_108_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	108	0	1	01	01	H1019_108_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	108	0	1	01	01	H1019_108_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	109	0	1	01	01	H1019_109_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	109	0	1	01	01	H1019_109_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	109	0	1	01	01	H1019_109_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	109	0	1	01	01	H1019_109_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	109	0	1	01	01	H1019_109_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	110	0	1	02	01	H1019_110_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	110	0	1	02	01	H1019_110_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	110	0	1	02	01	H1019_110_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	110	0	1	02	01	H1019_110_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	110	0	1	02	01	H1019_110_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	111	0	1	01	01	H1019_111_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	111	0	1	01	01	H1019_111_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	111	0	1	01	01	H1019_111_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	111	0	1	01	01	H1019_111_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	111	0	1	01	01	H1019_111_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	112	0	1	01	01	H1019_112_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	112	0	1	01	01	H1019_112_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	112	0	1	01	01	H1019_112_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	112	0	1	01	01	H1019_112_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	112	0	1	01	01	H1019_112_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1019	113	0	1	01	01	H1019_113_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1019	113	0	1	01	01	H1019_113_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1019	113	0	1	01	01	H1019_113_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1019	113	0	1	01	01	H1019_113_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1019	113	0	1	01	01	H1019_113_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	040	0	1	01	01	H1032_040_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	040	0	1	01	01	H1032_040_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	040	0	1	01	01	H1032_040_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	040	0	1	01	01	H1032_040_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	040	0	1	01	01	H1032_040_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	124	0	1	01	01	H1032_124_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	124	0	1	01	01	H1032_124_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	124	0	1	01	01	H1032_124_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	124	0	1	01	01	H1032_124_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	124	0	1	01	01	H1032_124_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	170	0	1	01	01	H1032_170_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	170	0	1	01	01	H1032_170_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	170	0	1	01	01	H1032_170_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	170	0	1	01	01	H1032_170_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	170	0	1	01	01	H1032_170_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	175	0	1	01	01	H1032_175_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	175	0	1	01	01	H1032_175_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	175	0	1	01	01	H1032_175_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	175	0	1	01	01	H1032_175_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	175	0	1	01	01	H1032_175_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	176	0	1	01	01	H1032_176_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	176	0	1	01	01	H1032_176_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	176	0	1	01	01	H1032_176_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	176	0	1	01	01	H1032_176_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	176	0	1	01	01	H1032_176_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	182	0	1	01	01	H1032_182_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	182	0	1	01	01	H1032_182_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	182	0	1	01	01	H1032_182_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	182	0	1	01	01	H1032_182_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	182	0	1	01	01	H1032_182_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	184	0	1	01	01	H1032_184_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	184	0	1	01	01	H1032_184_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	184	0	1	01	01	H1032_184_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	184	0	1	01	01	H1032_184_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	184	0	1	01	01	H1032_184_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	184	0	1	01	01	H1032_184_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	186	0	1	01	01	H1032_186_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	186	0	1	01	01	H1032_186_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	186	0	1	01	01	H1032_186_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	186	0	1	01	01	H1032_186_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	186	0	1	01	01	H1032_186_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	186	0	1	01	01	H1032_186_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	189	0	1	01	01	H1032_189_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	189	0	1	01	01	H1032_189_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	189	0	1	01	01	H1032_189_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	189	0	1	01	01	H1032_189_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	189	0	1	01	01	H1032_189_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	190	0	1	01	01	H1032_190_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	190	0	1	01	01	H1032_190_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	190	0	1	01	01	H1032_190_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	190	0	1	01	01	H1032_190_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	190	0	1	01	01	H1032_190_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	191	0	1	01	01	H1032_191_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	191	0	1	01	01	H1032_191_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	191	0	1	01	01	H1032_191_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	191	0	1	01	01	H1032_191_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	191	0	1	01	01	H1032_191_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	192	0	1	01	01	H1032_192_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	192	0	1	01	01	H1032_192_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	192	0	1	01	01	H1032_192_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	192	0	1	01	01	H1032_192_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	192	0	1	01	01	H1032_192_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	193	0	1	01	01	H1032_193_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	193	0	1	01	01	H1032_193_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	193	0	1	01	01	H1032_193_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	193	0	1	01	01	H1032_193_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	193	0	1	01	01	H1032_193_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	194	0	1	01	01	H1032_194_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	194	0	1	01	01	H1032_194_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	194	0	1	01	01	H1032_194_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	194	0	1	01	01	H1032_194_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	194	0	1	01	01	H1032_194_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	195	0	1	01	01	H1032_195_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	195	0	1	01	01	H1032_195_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	195	0	1	01	01	H1032_195_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	195	0	1	01	01	H1032_195_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	195	0	1	01	01	H1032_195_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	196	0	1	01	01	H1032_196_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	196	0	1	01	01	H1032_196_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	196	0	1	01	01	H1032_196_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	196	0	1	01	01	H1032_196_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	196	0	1	01	01	H1032_196_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	197	0	1	01	01	H1032_197_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	197	0	1	01	01	H1032_197_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	197	0	1	01	01	H1032_197_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	197	0	1	01	01	H1032_197_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	197	0	1	01	01	H1032_197_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	198	0	1	01	01	H1032_198_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	198	0	1	01	01	H1032_198_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	198	0	1	01	01	H1032_198_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	198	0	1	01	01	H1032_198_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	198	0	1	01	01	H1032_198_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	199	0	1	01	01	H1032_199_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	199	0	1	01	01	H1032_199_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	199	0	1	01	01	H1032_199_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	199	0	1	01	01	H1032_199_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	199	0	1	01	01	H1032_199_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	200	0	1	01	01	H1032_200_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	200	0	1	01	01	H1032_200_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	200	0	1	01	01	H1032_200_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	200	0	1	01	01	H1032_200_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	200	0	1	01	01	H1032_200_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	201	0	1	01	01	H1032_201_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	201	0	1	01	01	H1032_201_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	201	0	1	01	01	H1032_201_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	201	0	1	01	01	H1032_201_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	201	0	1	01	01	H1032_201_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	202	0	1	01	01	H1032_202_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	202	0	1	01	01	H1032_202_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	202	0	1	01	01	H1032_202_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	202	0	1	01	01	H1032_202_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	202	0	1	01	01	H1032_202_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	203	0	1	01	01	H1032_203_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	203	0	1	01	01	H1032_203_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	203	0	1	01	01	H1032_203_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	203	0	1	01	01	H1032_203_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	203	0	1	01	01	H1032_203_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	203	0	1	01	01	H1032_203_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	204	0	1	01	01	H1032_204_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	204	0	1	01	01	H1032_204_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	204	0	1	01	01	H1032_204_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	204	0	1	01	01	H1032_204_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	204	0	1	01	01	H1032_204_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	205	0	1	01	01	H1032_205_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	205	0	1	01	01	H1032_205_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	205	0	1	01	01	H1032_205_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	205	0	1	01	01	H1032_205_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	205	0	1	01	01	H1032_205_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	206	0	1	01	01	H1032_206_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	206	0	1	01	01	H1032_206_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	206	0	1	01	01	H1032_206_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	206	0	1	01	01	H1032_206_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	206	0	1	01	01	H1032_206_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	209	0	1	01	01	H1032_209_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	209	0	1	01	01	H1032_209_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	209	0	1	01	01	H1032_209_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	209	0	1	01	01	H1032_209_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	209	0	1	01	01	H1032_209_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	210	0	1	01	01	H1032_210_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	210	0	1	01	01	H1032_210_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	210	0	1	01	01	H1032_210_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	210	0	1	01	01	H1032_210_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	210	0	1	01	01	H1032_210_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	211	0	1	01	01	H1032_211_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	211	0	1	01	01	H1032_211_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	211	0	1	01	01	H1032_211_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	211	0	1	01	01	H1032_211_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	211	0	1	01	01	H1032_211_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	212	0	1	01	01	H1032_212_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	212	0	1	01	01	H1032_212_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	212	0	1	01	01	H1032_212_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	212	0	1	01	01	H1032_212_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	212	0	1	01	01	H1032_212_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	213	0	1	01	01	H1032_213_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	213	0	1	01	01	H1032_213_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	213	0	1	01	01	H1032_213_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	213	0	1	01	01	H1032_213_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	213	0	1	01	01	H1032_213_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	214	0	1	01	01	H1032_214_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	214	0	1	01	01	H1032_214_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	214	0	1	01	01	H1032_214_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	214	0	1	01	01	H1032_214_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	214	0	1	01	01	H1032_214_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	215	0	1	01	01	H1032_215_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	215	0	1	01	01	H1032_215_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	215	0	1	01	01	H1032_215_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	215	0	1	01	01	H1032_215_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	215	0	1	01	01	H1032_215_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	216	0	1	01	01	H1032_216_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	216	0	1	01	01	H1032_216_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	216	0	1	01	01	H1032_216_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	216	0	1	01	01	H1032_216_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	216	0	1	01	01	H1032_216_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	217	0	1	01	01	H1032_217_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	217	0	1	01	01	H1032_217_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	217	0	1	01	01	H1032_217_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	217	0	1	01	01	H1032_217_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	217	0	1	01	01	H1032_217_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	218	0	1	01	01	H1032_218_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	218	0	1	01	01	H1032_218_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	218	0	1	01	01	H1032_218_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	218	0	1	01	01	H1032_218_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	218	0	1	01	01	H1032_218_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	224	0	1	01	01	H1032_224_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	224	0	1	01	01	H1032_224_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	224	0	1	01	01	H1032_224_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	224	0	1	01	01	H1032_224_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	224	0	1	01	01	H1032_224_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	224	0	1	01	01	H1032_224_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	225	0	1	01	01	H1032_225_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	225	0	1	01	01	H1032_225_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	225	0	1	01	01	H1032_225_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	225	0	1	01	01	H1032_225_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	225	0	1	01	01	H1032_225_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	225	0	1	01	01	H1032_225_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	226	0	1	01	01	H1032_226_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	226	0	1	01	01	H1032_226_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	226	0	1	01	01	H1032_226_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	226	0	1	01	01	H1032_226_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	226	0	1	01	01	H1032_226_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	226	0	1	01	01	H1032_226_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	227	0	1	01	01	H1032_227_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	227	0	1	01	01	H1032_227_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	227	0	1	01	01	H1032_227_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	227	0	1	01	01	H1032_227_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	227	0	1	01	01	H1032_227_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	227	0	1	01	01	H1032_227_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	228	0	1	01	01	H1032_228_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	228	0	1	01	01	H1032_228_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	228	0	1	01	01	H1032_228_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	228	0	1	01	01	H1032_228_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	228	0	1	01	01	H1032_228_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	228	0	1	01	01	H1032_228_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	229	1	1	01	01	H1032_229_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	229	1	1	01	01	H1032_229_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	229	1	1	01	01	H1032_229_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	229	1	1	01	01	H1032_229_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	229	1	1	01	01	H1032_229_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	229	2	1	01	01	H1032_229_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	229	2	1	01	01	H1032_229_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	229	2	1	01	01	H1032_229_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	229	2	1	01	01	H1032_229_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	229	2	1	01	01	H1032_229_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	229	3	1	01	01	H1032_229_3	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1032	229	3	1	01	01	H1032_229_3	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1032	229	3	1	01	01	H1032_229_3	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1032	229	3	1	01	01	H1032_229_3	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1032	229	3	1	01	01	H1032_229_3	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1032	230	0	1	01	01	H1032_230_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	230	0	1	01	01	H1032_230_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	230	0	1	01	01	H1032_230_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	230	0	1	01	01	H1032_230_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	230	0	1	01	01	H1032_230_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	230	0	1	01	01	H1032_230_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	231	0	1	01	01	H1032_231_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	231	0	1	01	01	H1032_231_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	231	0	1	01	01	H1032_231_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	231	0	1	01	01	H1032_231_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	231	0	1	01	01	H1032_231_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	231	0	1	01	01	H1032_231_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	232	0	1	01	01	H1032_232_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	232	0	1	01	01	H1032_232_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	232	0	1	01	01	H1032_232_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	232	0	1	01	01	H1032_232_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	232	0	1	01	01	H1032_232_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	232	0	1	01	01	H1032_232_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1032	233	0	1	01	01	H1032_233_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1032	233	0	1	01	01	H1032_233_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1032	233	0	1	01	01	H1032_233_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1032	233	0	1	01	01	H1032_233_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1032	233	0	1	01	01	H1032_233_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1032	233	0	1	01	01	H1032_233_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1035	002	0	1	02	01	H1035_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1035	002	0	1	02	01	H1035_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1035	002	0	1	02	01	H1035_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1035	002	0	1	02	01	H1035_002_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1035	002	0	1	02	01	H1035_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1035	006	0	1	01	01	H1035_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1035	006	0	1	01	01	H1035_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1035	006	0	1	01	01	H1035_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1035	006	0	1	01	01	H1035_006_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1035	006	0	1	01	01	H1035_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1035	011	0	1	01	01	H1035_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1035	011	0	1	01	01	H1035_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1035	011	0	1	01	01	H1035_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1035	011	0	1	01	01	H1035_011_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1035	011	0	1	01	01	H1035_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1035	014	0	1	01	01	H1035_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1035	014	0	1	01	01	H1035_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1035	014	0	1	01	01	H1035_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1035	014	0	1	01	01	H1035_014_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1035	014	0	1	01	01	H1035_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1035	016	0	1	01	01	H1035_016_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1035	016	0	1	01	01	H1035_016_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1035	016	0	1	01	01	H1035_016_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1035	016	0	1	01	01	H1035_016_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1035	016	0	1	01	01	H1035_016_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1035	017	0	1	01	01	H1035_017_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1035	017	0	1	01	01	H1035_017_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	017	0	1	01	01	H1035_017_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	017	0	1	01	01	H1035_017_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	017	0	1	01	01	H1035_017_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	018	0	1	01	01	H1035_018_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1035	018	0	1	01	01	H1035_018_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1035	018	0	1	01	01	H1035_018_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1035	018	0	1	01	01	H1035_018_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1035	018	0	1	01	01	H1035_018_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1035	018	0	1	01	01	H1035_018_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1035	019	0	1	01	01	H1035_019_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1035	019	0	1	01	01	H1035_019_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1035	019	0	1	01	01	H1035_019_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1035	019	0	1	01	01	H1035_019_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1035	019	0	1	01	01	H1035_019_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1035	019	0	1	01	01	H1035_019_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1035	020	0	1	01	01	H1035_020_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1035	020	0	1	01	01	H1035_020_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1035	020	0	1	01	01	H1035_020_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1035	020	0	1	01	01	H1035_020_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1035	020	0	1	01	01	H1035_020_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1035	020	0	1	01	01	H1035_020_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1035	021	0	1	01	01	H1035_021_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1035	021	0	1	01	01	H1035_021_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1035	021	0	1	01	01	H1035_021_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1035	021	0	1	01	01	H1035_021_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1035	021	0	1	01	01	H1035_021_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1035	021	0	1	01	01	H1035_021_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1035	022	0	1	01	01	H1035_022_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	022	0	1	01	01	H1035_022_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	022	0	1	01	01	H1035_022_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	022	0	1	01	01	H1035_022_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	022	0	1	01	01	H1035_022_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	023	0	1	01	01	H1035_023_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	023	0	1	01	01	H1035_023_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	023	0	1	01	01	H1035_023_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	023	0	1	01	01	H1035_023_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	023	0	1	01	01	H1035_023_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	024	0	1	01	01	H1035_024_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	024	0	1	01	01	H1035_024_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	024	0	1	01	01	H1035_024_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	024	0	1	01	01	H1035_024_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	024	0	1	01	01	H1035_024_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	025	0	1	01	01	H1035_025_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	025	0	1	01	01	H1035_025_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	025	0	1	01	01	H1035_025_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	025	0	1	01	01	H1035_025_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	025	0	1	01	01	H1035_025_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	026	0	1	01	01	H1035_026_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	026	0	1	01	01	H1035_026_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	026	0	1	01	01	H1035_026_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	026	0	1	01	01	H1035_026_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	026	0	1	01	01	H1035_026_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	027	0	1	01	01	H1035_027_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	027	0	1	01	01	H1035_027_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	027	0	1	01	01	H1035_027_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	027	0	1	01	01	H1035_027_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	027	0	1	01	01	H1035_027_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	028	0	1	01	01	H1035_028_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	028	0	1	01	01	H1035_028_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	028	0	1	01	01	H1035_028_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	028	0	1	01	01	H1035_028_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	028	0	1	01	01	H1035_028_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	029	0	1	01	01	H1035_029_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	029	0	1	01	01	H1035_029_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	029	0	1	01	01	H1035_029_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	029	0	1	01	01	H1035_029_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	029	0	1	01	01	H1035_029_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	030	0	1	01	01	H1035_030_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	030	0	1	01	01	H1035_030_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	030	0	1	01	01	H1035_030_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	030	0	1	01	01	H1035_030_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	030	0	1	01	01	H1035_030_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	031	0	1	01	01	H1035_031_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	031	0	1	01	01	H1035_031_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	031	0	1	01	01	H1035_031_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	031	0	1	01	01	H1035_031_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	031	0	1	01	01	H1035_031_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	032	0	1	01	01	H1035_032_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	032	0	1	01	01	H1035_032_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	032	0	1	01	01	H1035_032_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	032	0	1	01	01	H1035_032_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	032	0	1	01	01	H1035_032_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	033	0	1	01	01	H1035_033_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	033	0	1	01	01	H1035_033_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	033	0	1	01	01	H1035_033_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	033	0	1	01	01	H1035_033_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	033	0	1	01	01	H1035_033_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	034	0	1	01	01	H1035_034_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	034	0	1	01	01	H1035_034_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	034	0	1	01	01	H1035_034_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	034	0	1	01	01	H1035_034_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	034	0	1	01	01	H1035_034_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	035	0	1	01	01	H1035_035_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1035	035	0	1	01	01	H1035_035_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1035	035	0	1	01	01	H1035_035_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1035	035	0	1	01	01	H1035_035_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1035	035	0	1	01	01	H1035_035_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1035	035	0	1	01	01	H1035_035_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1035	037	0	1	01	01	H1035_037_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1035	037	0	1	01	01	H1035_037_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1035	037	0	1	01	01	H1035_037_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1035	037	0	1	01	01	H1035_037_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1035	037	0	1	01	01	H1035_037_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1035	037	0	1	01	01	H1035_037_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1035	038	0	1	01	01	H1035_038_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1035	038	0	1	01	01	H1035_038_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1035	038	0	1	01	01	H1035_038_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1035	038	0	1	01	01	H1035_038_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1035	038	0	1	01	01	H1035_038_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1035	038	0	1	01	01	H1035_038_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1035	039	0	1	01	01	H1035_039_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1035	039	0	1	01	01	H1035_039_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	039	0	1	01	01	H1035_039_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	039	0	1	01	01	H1035_039_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	039	0	1	01	01	H1035_039_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	040	0	1	01	01	H1035_040_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1035	040	0	1	01	01	H1035_040_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1035	040	0	1	01	01	H1035_040_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1035	040	0	1	01	01	H1035_040_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1035	040	0	1	01	01	H1035_040_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1035	043	0	1	01	01	H1035_043_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	043	0	1	01	01	H1035_043_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	043	0	1	01	01	H1035_043_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	043	0	1	01	01	H1035_043_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	043	0	1	01	01	H1035_043_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1035	044	0	1	02	01	H1035_044_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1035	044	0	1	02	01	H1035_044_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1035	044	0	1	02	01	H1035_044_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1035	044	0	1	02	01	H1035_044_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1035	044	0	1	02	01	H1035_044_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1035	045	0	1	01	01	H1035_045_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1035	045	0	1	01	01	H1035_045_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1035	045	0	1	01	01	H1035_045_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1035	045	0	1	01	01	H1035_045_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1035	045	0	1	01	01	H1035_045_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	025	0	1	01	01	H1036_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	025	0	1	01	01	H1036_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	025	0	1	01	01	H1036_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	025	0	1	01	01	H1036_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	025	0	1	01	01	H1036_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	044	0	1	01	01	H1036_044_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	044	0	1	01	01	H1036_044_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	044	0	1	01	01	H1036_044_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	044	0	1	01	01	H1036_044_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	044	0	1	01	01	H1036_044_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	054	0	1	01	01	H1036_054_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	054	0	1	01	01	H1036_054_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	054	0	1	01	01	H1036_054_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	054	0	1	01	01	H1036_054_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	054	0	1	01	01	H1036_054_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	062	0	1	01	01	H1036_062_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	062	0	1	01	01	H1036_062_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	062	0	1	01	01	H1036_062_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	062	0	1	01	01	H1036_062_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	062	0	1	01	01	H1036_062_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	065	0	1	01	01	H1036_065_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	065	0	1	01	01	H1036_065_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	065	0	1	01	01	H1036_065_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	065	0	1	01	01	H1036_065_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	065	0	1	01	01	H1036_065_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	068	0	1	01	01	H1036_068_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	068	0	1	01	01	H1036_068_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	068	0	1	01	01	H1036_068_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	068	0	1	01	01	H1036_068_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	068	0	1	01	01	H1036_068_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	074	0	1	01	01	H1036_074_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	074	0	1	01	01	H1036_074_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	074	0	1	01	01	H1036_074_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	074	0	1	01	01	H1036_074_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	074	0	1	01	01	H1036_074_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	077	0	1	01	01	H1036_077_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	077	0	1	01	01	H1036_077_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	077	0	1	01	01	H1036_077_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	077	0	1	01	01	H1036_077_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	077	0	1	01	01	H1036_077_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	081	0	1	01	01	H1036_081_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	081	0	1	01	01	H1036_081_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	081	0	1	01	01	H1036_081_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	081	0	1	01	01	H1036_081_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	081	0	1	01	01	H1036_081_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	102	0	1	01	01	H1036_102_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	102	0	1	01	01	H1036_102_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	102	0	1	01	01	H1036_102_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	102	0	1	01	01	H1036_102_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	102	0	1	01	01	H1036_102_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	103	0	1	01	01	H1036_103_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	103	0	1	01	01	H1036_103_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	103	0	1	01	01	H1036_103_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	103	0	1	01	01	H1036_103_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	103	0	1	01	01	H1036_103_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	104	0	1	01	01	H1036_104_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	104	0	1	01	01	H1036_104_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	104	0	1	01	01	H1036_104_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	104	0	1	01	01	H1036_104_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	104	0	1	01	01	H1036_104_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	121	0	1	01	01	H1036_121_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	121	0	1	01	01	H1036_121_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	121	0	1	01	01	H1036_121_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	121	0	1	01	01	H1036_121_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	121	0	1	01	01	H1036_121_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	137	0	1	01	01	H1036_137_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	137	0	1	01	01	H1036_137_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	137	0	1	01	01	H1036_137_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	137	0	1	01	01	H1036_137_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	137	0	1	01	01	H1036_137_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	140	0	1	01	01	H1036_140_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	140	0	1	01	01	H1036_140_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	140	0	1	01	01	H1036_140_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	140	0	1	01	01	H1036_140_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	140	0	1	01	01	H1036_140_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	143	0	1	01	01	H1036_143_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	143	0	1	01	01	H1036_143_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	143	0	1	01	01	H1036_143_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	143	0	1	01	01	H1036_143_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	143	0	1	01	01	H1036_143_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	146	0	1	01	01	H1036_146_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	146	0	1	01	01	H1036_146_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	146	0	1	01	01	H1036_146_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	146	0	1	01	01	H1036_146_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	146	0	1	01	01	H1036_146_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	151	0	1	01	01	H1036_151_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	151	0	1	01	01	H1036_151_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	151	0	1	01	01	H1036_151_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	151	0	1	01	01	H1036_151_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	151	0	1	01	01	H1036_151_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	153	0	1	01	01	H1036_153_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	153	0	1	01	01	H1036_153_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	153	0	1	01	01	H1036_153_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	153	0	1	01	01	H1036_153_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	153	0	1	01	01	H1036_153_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	156	0	1	01	01	H1036_156_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1036	156	0	1	01	01	H1036_156_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1036	156	0	1	01	01	H1036_156_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1036	156	0	1	01	01	H1036_156_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1036	156	0	1	01	01	H1036_156_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1036	156	0	1	01	01	H1036_156_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1036	157	0	1	01	01	H1036_157_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	157	0	1	01	01	H1036_157_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	157	0	1	01	01	H1036_157_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	157	0	1	01	01	H1036_157_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	157	0	1	01	01	H1036_157_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	160	0	1	01	01	H1036_160_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1036	160	0	1	01	01	H1036_160_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1036	160	0	1	01	01	H1036_160_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1036	160	0	1	01	01	H1036_160_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1036	160	0	1	01	01	H1036_160_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1036	160	0	1	01	01	H1036_160_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1036	167	0	1	01	01	H1036_167_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	167	0	1	01	01	H1036_167_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	167	0	1	01	01	H1036_167_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	167	0	1	01	01	H1036_167_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	167	0	1	01	01	H1036_167_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	168	0	1	01	01	H1036_168_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	168	0	1	01	01	H1036_168_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	168	0	1	01	01	H1036_168_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	168	0	1	01	01	H1036_168_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	168	0	1	01	01	H1036_168_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	171	0	1	01	01	H1036_171_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	171	0	1	01	01	H1036_171_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	171	0	1	01	01	H1036_171_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	171	0	1	01	01	H1036_171_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	171	0	1	01	01	H1036_171_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	175	0	1	01	01	H1036_175_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1036	175	0	1	01	01	H1036_175_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1036	175	0	1	01	01	H1036_175_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1036	175	0	1	01	01	H1036_175_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1036	175	0	1	01	01	H1036_175_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1036	175	0	1	01	01	H1036_175_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1036	199	0	1	01	01	H1036_199_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	199	0	1	01	01	H1036_199_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	199	0	1	01	01	H1036_199_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	199	0	1	01	01	H1036_199_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	199	0	1	01	01	H1036_199_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	209	0	1	01	01	H1036_209_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	209	0	1	01	01	H1036_209_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	209	0	1	01	01	H1036_209_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	209	0	1	01	01	H1036_209_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	209	0	1	01	01	H1036_209_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	210	0	1	01	01	H1036_210_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	210	0	1	01	01	H1036_210_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	210	0	1	01	01	H1036_210_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	210	0	1	01	01	H1036_210_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	210	0	1	01	01	H1036_210_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	213	0	1	01	01	H1036_213_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	213	0	1	01	01	H1036_213_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	213	0	1	01	01	H1036_213_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	213	0	1	01	01	H1036_213_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	213	0	1	01	01	H1036_213_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	214	0	1	01	01	H1036_214_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	214	0	1	01	01	H1036_214_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	214	0	1	01	01	H1036_214_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	214	0	1	01	01	H1036_214_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	214	0	1	01	01	H1036_214_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	217	0	1	01	01	H1036_217_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	217	0	1	01	01	H1036_217_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	217	0	1	01	01	H1036_217_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	217	0	1	01	01	H1036_217_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	217	0	1	01	01	H1036_217_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	219	0	1	01	01	H1036_219_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	219	0	1	01	01	H1036_219_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	219	0	1	01	01	H1036_219_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	219	0	1	01	01	H1036_219_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	219	0	1	01	01	H1036_219_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	222	0	1	01	01	H1036_222_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	222	0	1	01	01	H1036_222_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	222	0	1	01	01	H1036_222_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	222	0	1	01	01	H1036_222_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	222	0	1	01	01	H1036_222_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	223	0	1	01	01	H1036_223_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	223	0	1	01	01	H1036_223_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	223	0	1	01	01	H1036_223_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	223	0	1	01	01	H1036_223_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	223	0	1	01	01	H1036_223_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	226	0	1	01	01	H1036_226_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	226	0	1	01	01	H1036_226_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	226	0	1	01	01	H1036_226_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	226	0	1	01	01	H1036_226_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	226	0	1	01	01	H1036_226_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	229	0	1	01	01	H1036_229_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	229	0	1	01	01	H1036_229_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	229	0	1	01	01	H1036_229_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	229	0	1	01	01	H1036_229_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	229	0	1	01	01	H1036_229_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	230	0	1	01	01	H1036_230_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	230	0	1	01	01	H1036_230_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	230	0	1	01	01	H1036_230_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	230	0	1	01	01	H1036_230_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	230	0	1	01	01	H1036_230_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	231	0	1	01	01	H1036_231_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	231	0	1	01	01	H1036_231_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	231	0	1	01	01	H1036_231_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	231	0	1	01	01	H1036_231_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	231	0	1	01	01	H1036_231_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	233	0	1	01	01	H1036_233_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	233	0	1	01	01	H1036_233_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	233	0	1	01	01	H1036_233_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	233	0	1	01	01	H1036_233_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	233	0	1	01	01	H1036_233_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	234	0	1	01	01	H1036_234_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1036	234	0	1	01	01	H1036_234_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1036	234	0	1	01	01	H1036_234_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1036	234	0	1	01	01	H1036_234_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1036	234	0	1	01	01	H1036_234_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1036	234	0	1	01	01	H1036_234_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1036	235	0	1	01	01	H1036_235_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	235	0	1	01	01	H1036_235_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	235	0	1	01	01	H1036_235_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	235	0	1	01	01	H1036_235_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	235	0	1	01	01	H1036_235_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	236	0	1	01	01	H1036_236_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	236	0	1	01	01	H1036_236_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	236	0	1	01	01	H1036_236_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	236	0	1	01	01	H1036_236_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	236	0	1	01	01	H1036_236_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	237	1	1	01	01	H1036_237_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	237	1	1	01	01	H1036_237_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	237	1	1	01	01	H1036_237_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	237	1	1	01	01	H1036_237_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	237	1	1	01	01	H1036_237_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	237	2	1	01	01	H1036_237_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	237	2	1	01	01	H1036_237_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	237	2	1	01	01	H1036_237_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	237	2	1	01	01	H1036_237_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	237	2	1	01	01	H1036_237_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	243	0	1	01	01	H1036_243_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	243	0	1	01	01	H1036_243_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	243	0	1	01	01	H1036_243_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	243	0	1	01	01	H1036_243_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	243	0	1	01	01	H1036_243_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	245	0	1	01	01	H1036_245_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	245	0	1	01	01	H1036_245_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	245	0	1	01	01	H1036_245_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	245	0	1	01	01	H1036_245_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	245	0	1	01	01	H1036_245_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	249	0	1	01	01	H1036_249_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	249	0	1	01	01	H1036_249_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	249	0	1	01	01	H1036_249_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	249	0	1	01	01	H1036_249_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	249	0	1	01	01	H1036_249_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	261	0	1	01	01	H1036_261_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	261	0	1	01	01	H1036_261_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	261	0	1	01	01	H1036_261_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	261	0	1	01	01	H1036_261_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	261	0	1	01	01	H1036_261_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	262	0	1	01	01	H1036_262_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	262	0	1	01	01	H1036_262_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	262	0	1	01	01	H1036_262_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	262	0	1	01	01	H1036_262_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	262	0	1	01	01	H1036_262_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	265	1	1	01	01	H1036_265_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	265	1	1	01	01	H1036_265_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	265	1	1	01	01	H1036_265_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	265	1	1	01	01	H1036_265_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	265	1	1	01	01	H1036_265_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	265	2	1	01	01	H1036_265_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	265	2	1	01	01	H1036_265_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	265	2	1	01	01	H1036_265_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	265	2	1	01	01	H1036_265_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	265	2	1	01	01	H1036_265_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	266	0	1	01	01	H1036_266_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	266	0	1	01	01	H1036_266_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	266	0	1	01	01	H1036_266_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	266	0	1	01	01	H1036_266_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	266	0	1	01	01	H1036_266_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	268	0	1	01	01	H1036_268_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	268	0	1	01	01	H1036_268_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	268	0	1	01	01	H1036_268_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	268	0	1	01	01	H1036_268_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	268	0	1	01	01	H1036_268_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	269	0	1	01	01	H1036_269_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	269	0	1	01	01	H1036_269_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	269	0	1	01	01	H1036_269_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	269	0	1	01	01	H1036_269_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	269	0	1	01	01	H1036_269_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	270	0	1	01	01	H1036_270_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	270	0	1	01	01	H1036_270_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	270	0	1	01	01	H1036_270_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	270	0	1	01	01	H1036_270_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	270	0	1	01	01	H1036_270_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	271	0	1	01	01	H1036_271_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	271	0	1	01	01	H1036_271_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	271	0	1	01	01	H1036_271_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	271	0	1	01	01	H1036_271_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	271	0	1	01	01	H1036_271_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	276	0	1	01	01	H1036_276_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	276	0	1	01	01	H1036_276_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	276	0	1	01	01	H1036_276_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	276	0	1	01	01	H1036_276_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	276	0	1	01	01	H1036_276_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	277	0	1	01	01	H1036_277_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	277	0	1	01	01	H1036_277_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	277	0	1	01	01	H1036_277_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	277	0	1	01	01	H1036_277_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	277	0	1	01	01	H1036_277_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	278	0	1	01	01	H1036_278_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	278	0	1	01	01	H1036_278_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	278	0	1	01	01	H1036_278_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	278	0	1	01	01	H1036_278_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	278	0	1	01	01	H1036_278_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	280	0	1	01	01	H1036_280_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	280	0	1	01	01	H1036_280_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	280	0	1	01	01	H1036_280_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	280	0	1	01	01	H1036_280_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	280	0	1	01	01	H1036_280_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	281	0	1	01	01	H1036_281_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	281	0	1	01	01	H1036_281_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	281	0	1	01	01	H1036_281_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	281	0	1	01	01	H1036_281_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	281	0	1	01	01	H1036_281_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	282	0	1	01	01	H1036_282_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	282	0	1	01	01	H1036_282_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	282	0	1	01	01	H1036_282_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	282	0	1	01	01	H1036_282_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	282	0	1	01	01	H1036_282_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	283	0	1	01	01	H1036_283_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	283	0	1	01	01	H1036_283_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	283	0	1	01	01	H1036_283_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	283	0	1	01	01	H1036_283_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	283	0	1	01	01	H1036_283_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	284	0	1	01	01	H1036_284_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	284	0	1	01	01	H1036_284_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	284	0	1	01	01	H1036_284_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	284	0	1	01	01	H1036_284_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	284	0	1	01	01	H1036_284_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	285	0	1	01	01	H1036_285_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	285	0	1	01	01	H1036_285_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	285	0	1	01	01	H1036_285_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	285	0	1	01	01	H1036_285_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	285	0	1	01	01	H1036_285_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	286	0	1	01	01	H1036_286_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1036	286	0	1	01	01	H1036_286_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	286	0	1	01	01	H1036_286_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	286	0	1	01	01	H1036_286_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	286	0	1	01	01	H1036_286_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1036	291	0	1	01	01	H1036_291_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1036	291	0	1	01	01	H1036_291_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1036	291	0	1	01	01	H1036_291_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1036	291	0	1	01	01	H1036_291_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1036	291	0	1	01	01	H1036_291_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	001	0	1	01	01	H1045_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	001	0	1	01	01	H1045_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	001	0	1	01	01	H1045_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	001	0	1	01	01	H1045_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	001	0	1	01	01	H1045_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	005	0	1	01	01	H1045_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	005	0	1	01	01	H1045_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	005	0	1	01	01	H1045_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	005	0	1	01	01	H1045_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	005	0	1	01	01	H1045_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	012	0	1	01	01	H1045_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	012	0	1	01	01	H1045_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	012	0	1	01	01	H1045_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	012	0	1	01	01	H1045_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	012	0	1	01	01	H1045_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	018	0	1	01	01	H1045_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	018	0	1	01	01	H1045_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	018	0	1	01	01	H1045_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	018	0	1	01	01	H1045_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	018	0	1	01	01	H1045_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	025	0	1	01	01	H1045_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	025	0	1	01	01	H1045_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	025	0	1	01	01	H1045_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	025	0	1	01	01	H1045_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	025	0	1	01	01	H1045_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	026	0	1	02	01	H1045_026_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	026	0	1	02	01	H1045_026_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	026	0	1	02	01	H1045_026_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	026	0	1	02	01	H1045_026_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	026	0	1	02	01	H1045_026_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	028	0	1	02	01	H1045_028_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	028	0	1	02	01	H1045_028_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	028	0	1	02	01	H1045_028_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	028	0	1	02	01	H1045_028_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	028	0	1	02	01	H1045_028_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	030	0	1	02	01	H1045_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	030	0	1	02	01	H1045_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	030	0	1	02	01	H1045_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	030	0	1	02	01	H1045_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	030	0	1	02	01	H1045_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	031	0	1	02	01	H1045_031_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	031	0	1	02	01	H1045_031_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	031	0	1	02	01	H1045_031_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	031	0	1	02	01	H1045_031_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	031	0	1	02	01	H1045_031_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	032	0	1	02	01	H1045_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	032	0	1	02	01	H1045_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	032	0	1	02	01	H1045_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	032	0	1	02	01	H1045_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	032	0	1	02	01	H1045_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	033	0	1	01	01	H1045_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	033	0	1	01	01	H1045_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	033	0	1	01	01	H1045_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	033	0	1	01	01	H1045_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	033	0	1	01	01	H1045_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	034	0	1	01	01	H1045_034_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	034	0	1	01	01	H1045_034_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	034	0	1	01	01	H1045_034_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	034	0	1	01	01	H1045_034_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	034	0	1	01	01	H1045_034_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	036	0	1	02	01	H1045_036_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	036	0	1	02	01	H1045_036_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	036	0	1	02	01	H1045_036_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	036	0	1	02	01	H1045_036_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	036	0	1	02	01	H1045_036_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	037	0	1	01	01	H1045_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	037	0	1	01	01	H1045_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	037	0	1	01	01	H1045_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	037	0	1	01	01	H1045_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	037	0	1	01	01	H1045_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	038	0	1	01	01	H1045_038_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	038	0	1	01	01	H1045_038_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	038	0	1	01	01	H1045_038_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	038	0	1	01	01	H1045_038_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	038	0	1	01	01	H1045_038_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	041	0	1	02	01	H1045_041_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	041	0	1	02	01	H1045_041_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	041	0	1	02	01	H1045_041_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	041	0	1	02	01	H1045_041_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	041	0	1	02	01	H1045_041_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	042	0	1	02	01	H1045_042_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	042	0	1	02	01	H1045_042_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	042	0	1	02	01	H1045_042_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	042	0	1	02	01	H1045_042_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	042	0	1	02	01	H1045_042_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	043	0	1	02	01	H1045_043_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	043	0	1	02	01	H1045_043_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	043	0	1	02	01	H1045_043_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	043	0	1	02	01	H1045_043_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	043	0	1	02	01	H1045_043_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	045	0	1	02	01	H1045_045_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	045	0	1	02	01	H1045_045_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	045	0	1	02	01	H1045_045_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	045	0	1	02	01	H1045_045_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	045	0	1	02	01	H1045_045_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	048	1	1	01	01	H1045_048_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	048	1	1	01	01	H1045_048_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	048	1	1	01	01	H1045_048_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	048	1	1	01	01	H1045_048_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	048	1	1	01	01	H1045_048_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	048	2	1	01	01	H1045_048_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	048	2	1	01	01	H1045_048_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	048	2	1	01	01	H1045_048_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	048	2	1	01	01	H1045_048_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	048	2	1	01	01	H1045_048_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	048	3	1	01	01	H1045_048_3	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	048	3	1	01	01	H1045_048_3	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	048	3	1	01	01	H1045_048_3	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	048	3	1	01	01	H1045_048_3	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	048	3	1	01	01	H1045_048_3	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1045	048	4	1	01	01	H1045_048_4	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1045	048	4	1	01	01	H1045_048_4	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1045	048	4	1	01	01	H1045_048_4	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1045	048	4	1	01	01	H1045_048_4	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1045	048	4	1	01	01	H1045_048_4	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1099	001	0	1	02	01	H1099_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1099	001	0	1	02	01	H1099_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1099	001	0	1	02	01	H1099_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1099	001	0	1	02	01	H1099_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1099	001	0	1	02	01	H1099_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1099	001	0	1	02	01	H1099_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1099	006	0	1	01	01	H1099_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1099	006	0	1	01	01	H1099_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1099	006	0	1	01	01	H1099_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1099	006	0	1	01	01	H1099_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1099	006	0	1	01	01	H1099_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1099	006	0	1	01	01	H1099_006_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1099	014	0	1	01	01	H1099_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1099	014	0	1	01	01	H1099_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1099	014	0	1	01	01	H1099_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1099	014	0	1	01	01	H1099_014_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1099	014	0	1	01	01	H1099_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1099	014	0	1	01	01	H1099_014_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1099	016	0	1	01	01	H1099_016_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1099	016	0	1	01	01	H1099_016_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1099	016	0	1	01	01	H1099_016_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1099	016	0	1	01	01	H1099_016_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1099	016	0	1	01	01	H1099_016_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1099	016	0	1	01	01	H1099_016_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1100	001	0	1	04	01	H1100_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1100	001	0	1	04	01	H1100_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1100	001	0	1	04	01	H1100_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1100	001	0	1	04	01	H1100_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1100	001	0	1	04	01	H1100_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1100	002	0	1	04	01	H1100_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1100	002	0	1	04	01	H1100_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1100	002	0	1	04	01	H1100_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1100	002	0	1	04	01	H1100_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1100	002	0	1	04	01	H1100_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1109	005	0	1	01	01	H1109_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1109	005	0	1	01	01	H1109_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1109	005	0	1	01	01	H1109_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1109	005	0	1	01	01	H1109_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1109	005	0	1	01	01	H1109_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1109	006	0	1	01	01	H1109_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1109	006	0	1	01	01	H1109_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1109	006	0	1	01	01	H1109_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1109	006	0	1	01	01	H1109_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1109	006	0	1	01	01	H1109_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1111	009	1	1	01	01	H1111_009_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1111	009	1	1	01	01	H1111_009_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1111	009	1	1	01	01	H1111_009_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1111	009	1	1	01	01	H1111_009_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1111	009	1	1	01	01	H1111_009_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1111	009	2	1	01	01	H1111_009_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1111	009	2	1	01	01	H1111_009_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1111	009	2	1	01	01	H1111_009_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1111	009	2	1	01	01	H1111_009_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1111	009	2	1	01	01	H1111_009_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1112	006	0	1	01	01	H1112_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1112	006	0	1	01	01	H1112_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1112	006	0	1	01	01	H1112_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1112	006	0	1	01	01	H1112_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1112	006	0	1	01	01	H1112_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1112	033	0	1	01	01	H1112_033_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1112	033	0	1	01	01	H1112_033_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1112	033	0	1	01	01	H1112_033_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1112	033	0	1	01	01	H1112_033_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1112	033	0	1	01	01	H1112_033_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1112	035	0	1	01	01	H1112_035_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1112	035	0	1	01	01	H1112_035_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1112	035	0	1	01	01	H1112_035_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1112	035	0	1	01	01	H1112_035_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1112	035	0	1	01	01	H1112_035_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1112	037	0	1	01	01	H1112_037_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1112	037	0	1	01	01	H1112_037_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1112	037	0	1	01	01	H1112_037_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1112	037	0	1	01	01	H1112_037_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1112	037	0	1	01	01	H1112_037_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1112	037	0	1	01	01	H1112_037_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1112	038	0	1	01	01	H1112_038_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1112	038	0	1	01	01	H1112_038_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1112	038	0	1	01	01	H1112_038_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1112	038	0	1	01	01	H1112_038_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1112	038	0	1	01	01	H1112_038_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1112	039	0	1	01	01	H1112_039_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1112	039	0	1	01	01	H1112_039_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1112	039	0	1	01	01	H1112_039_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1112	039	0	1	01	01	H1112_039_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1112	039	0	1	01	01	H1112_039_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1112	040	0	1	01	01	H1112_040_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1112	040	0	1	01	01	H1112_040_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1112	040	0	1	01	01	H1112_040_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1112	040	0	1	01	01	H1112_040_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1112	040	0	1	01	01	H1112_040_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1112	042	0	1	01	01	H1112_042_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1112	042	0	1	01	01	H1112_042_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1112	042	0	1	01	01	H1112_042_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1112	042	0	1	01	01	H1112_042_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1112	042	0	1	01	01	H1112_042_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1112	043	0	1	01	01	H1112_043_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1112	043	0	1	01	01	H1112_043_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1112	043	0	1	01	01	H1112_043_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1112	043	0	1	01	01	H1112_043_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1112	043	0	1	01	01	H1112_043_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1112	044	0	1	01	01	H1112_044_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1112	044	0	1	01	01	H1112_044_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1112	044	0	1	01	01	H1112_044_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1112	044	0	1	01	01	H1112_044_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1112	044	0	1	01	01	H1112_044_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1142	001	0	1	01	01	H1142_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1142	001	0	1	01	01	H1142_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1142	001	0	1	01	01	H1142_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1142	001	0	1	01	01	H1142_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1142	001	0	1	01	01	H1142_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1142	001	0	1	01	01	H1142_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H1142	002	0	1	01	01	H1142_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1142	002	0	1	01	01	H1142_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1142	002	0	1	01	01	H1142_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1142	002	0	1	01	01	H1142_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1142	002	0	1	01	01	H1142_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1142	002	0	1	01	01	H1142_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H1142	003	0	1	01	01	H1142_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1142	003	0	1	01	01	H1142_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1142	003	0	1	01	01	H1142_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1142	003	0	1	01	01	H1142_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1142	003	0	1	01	01	H1142_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1142	003	0	1	01	01	H1142_003_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H1142	013	0	1	01	01	H1142_013_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1142	013	0	1	01	01	H1142_013_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1142	013	0	1	01	01	H1142_013_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1142	013	0	1	01	01	H1142_013_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1142	013	0	1	01	01	H1142_013_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1142	013	0	1	01	01	H1142_013_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H1170	002	0	1	01	01	H1170_002_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	2.00				
H1170	002	0	1	01	01	H1170_002_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	2.00				
H1170	002	0	1	01	01	H1170_002_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	10.00				
H1170	002	0	1	01	01	H1170_002_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	10.00				
H1170	002	0	1	01	01	H1170_002_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	10.00				
H1170	002	0	1	01	01	H1170_002_0	10	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H1170	008	0	1	01	01	H1170_008_0	10	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H1170	008	0	1	01	01	H1170_008_0	10	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H1170	008	0	1	01	01	H1170_008_0	10	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H1170	008	0	1	01	01	H1170_008_0	10	Non-Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H1170	008	0	1	01	01	H1170_008_0	10	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H1170	008	0	1	01	01	H1170_008_0	10	Vaccines	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H1170	009	0	1	01	01	H1170_009_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	5.00				
H1170	009	0	1	01	01	H1170_009_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	5.00				
H1170	009	0	1	01	01	H1170_009_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	15.00				
H1170	009	0	1	01	01	H1170_009_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	15.00				
H1170	009	0	1	01	01	H1170_009_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	15.00				
H1170	009	0	1	01	01	H1170_009_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H1189	001	0	1	01	01	H1189_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1189	001	0	1	01	01	H1189_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1189	001	0	1	01	01	H1189_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1189	001	0	1	01	01	H1189_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H1189	001	0	1	01	01	H1189_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1189	002	0	1	01	01	H1189_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1189	002	0	1	01	01	H1189_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1189	002	0	1	01	01	H1189_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1189	002	0	1	01	01	H1189_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H1189	002	0	1	01	01	H1189_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1189	003	0	1	01	01	H1189_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1189	003	0	1	01	01	H1189_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1189	003	0	1	01	01	H1189_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1189	003	0	1	01	01	H1189_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H1189	003	0	1	01	01	H1189_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1189	004	0	1	01	01	H1189_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1189	004	0	1	01	01	H1189_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1189	004	0	1	01	01	H1189_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1189	004	0	1	01	01	H1189_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H1189	004	0	1	01	01	H1189_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1225	001	0	1	01	01	H1225_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1225	001	0	1	01	01	H1225_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1225	001	0	1	01	01	H1225_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1225	001	0	1	01	01	H1225_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1225	001	0	1	01	01	H1225_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1225	002	0	1	01	01	H1225_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1225	002	0	1	01	01	H1225_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1225	002	0	1	01	01	H1225_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1225	002	0	1	01	01	H1225_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1225	002	0	1	01	01	H1225_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1230	001	0	1	01	01	H1230_001_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	4.00				
H1230	001	0	1	01	01	H1230_001_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	4.00				
H1230	001	0	1	01	01	H1230_001_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	10.00				
H1230	001	0	1	01	01	H1230_001_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	10.00				
H1230	001	0	1	01	01	H1230_001_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	10.00				
H1230	001	0	1	01	01	H1230_001_0	12	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H1230	003	0	1	01	01	H1230_003_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	4.00				
H1230	003	0	1	01	01	H1230_003_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	4.00				
H1230	003	0	1	01	01	H1230_003_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	10.00				
H1230	003	0	1	01	01	H1230_003_0	13	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	10.00				
H1230	003	0	1	01	01	H1230_003_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	10.00				
H1230	003	0	1	01	01	H1230_003_0	13	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H1230	013	0	1	01	01	H1230_013_0	12	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	4.00				
H1230	013	0	1	01	01	H1230_013_0	12	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	4.00				
H1230	013	0	1	01	01	H1230_013_0	12	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	10.00				
H1230	013	0	1	01	01	H1230_013_0	12	Non-Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	10.00				
H1230	013	0	1	01	01	H1230_013_0	12	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	3	10.00	5			
H1230	013	0	1	01	01	H1230_013_0	12	Vaccines	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H1230	014	0	1	01	01	H1230_014_0	12	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	4.00				
H1230	014	0	1	01	01	H1230_014_0	12	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	4.00				
H1230	014	0	1	01	01	H1230_014_0	12	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	10.00				
H1230	014	0	1	01	01	H1230_014_0	12	Non-Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	10.00				
H1230	014	0	1	01	01	H1230_014_0	12	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	3	10.00	5			
H1230	014	0	1	01	01	H1230_014_0	12	Vaccines	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H1248	001	0	1	04	01	H1248_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1248	001	0	1	04	01	H1248_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1248	001	0	1	04	01	H1248_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1248	001	0	1	04	01	H1248_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1248	001	0	1	04	01	H1248_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1248	002	0	1	04	01	H1248_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1248	002	0	1	04	01	H1248_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1248	002	0	1	04	01	H1248_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1248	002	0	1	04	01	H1248_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1248	002	0	1	04	01	H1248_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1248	003	0	1	04	01	H1248_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1248	003	0	1	04	01	H1248_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1248	003	0	1	04	01	H1248_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1248	003	0	1	04	01	H1248_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1248	003	0	1	04	01	H1248_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1248	004	0	1	04	01	H1248_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1248	004	0	1	04	01	H1248_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1248	004	0	1	04	01	H1248_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1248	004	0	1	04	01	H1248_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1248	004	0	1	04	01	H1248_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1248	005	0	1	04	01	H1248_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1248	005	0	1	04	01	H1248_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1248	005	0	1	04	01	H1248_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1248	005	0	1	04	01	H1248_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1248	005	0	1	04	01	H1248_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1248	006	0	1	04	01	H1248_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1248	006	0	1	04	01	H1248_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1248	006	0	1	04	01	H1248_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1248	006	0	1	04	01	H1248_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1248	006	0	1	04	01	H1248_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1277	001	0	1	01	01	H1277_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1277	001	0	1	01	01	H1277_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1277	001	0	1	01	01	H1277_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1277	001	0	1	01	01	H1277_001_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1277	001	0	1	01	01	H1277_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1277	002	0	1	01	01	H1277_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1277	002	0	1	01	01	H1277_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1277	002	0	1	01	01	H1277_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1277	002	0	1	01	01	H1277_002_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1277	002	0	1	01	01	H1277_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1278	001	0	1	04	01	H1278_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	001	0	1	04	01	H1278_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	001	0	1	04	01	H1278_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	001	0	1	04	01	H1278_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	001	0	1	04	01	H1278_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	003	0	1	04	01	H1278_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	003	0	1	04	01	H1278_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	003	0	1	04	01	H1278_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	003	0	1	04	01	H1278_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	003	0	1	04	01	H1278_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	004	0	1	04	01	H1278_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	004	0	1	04	01	H1278_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	004	0	1	04	01	H1278_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	004	0	1	04	01	H1278_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	004	0	1	04	01	H1278_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	005	0	1	04	01	H1278_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	005	0	1	04	01	H1278_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	005	0	1	04	01	H1278_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	005	0	1	04	01	H1278_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	005	0	1	04	01	H1278_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	007	0	1	04	01	H1278_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	007	0	1	04	01	H1278_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	007	0	1	04	01	H1278_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	007	0	1	04	01	H1278_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	007	0	1	04	01	H1278_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	009	0	1	04	01	H1278_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	009	0	1	04	01	H1278_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	009	0	1	04	01	H1278_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	009	0	1	04	01	H1278_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	009	0	1	04	01	H1278_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	010	0	1	04	01	H1278_010_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	010	0	1	04	01	H1278_010_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	010	0	1	04	01	H1278_010_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	010	0	1	04	01	H1278_010_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	010	0	1	04	01	H1278_010_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	013	0	1	04	01	H1278_013_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	013	0	1	04	01	H1278_013_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	013	0	1	04	01	H1278_013_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	013	0	1	04	01	H1278_013_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	013	0	1	04	01	H1278_013_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	014	0	1	04	01	H1278_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	014	0	1	04	01	H1278_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	014	0	1	04	01	H1278_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	014	0	1	04	01	H1278_014_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	014	0	1	04	01	H1278_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	015	0	1	04	01	H1278_015_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	015	0	1	04	01	H1278_015_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	015	0	1	04	01	H1278_015_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	015	0	1	04	01	H1278_015_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	015	0	1	04	01	H1278_015_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1278	016	0	1	04	01	H1278_016_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1278	016	0	1	04	01	H1278_016_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1278	016	0	1	04	01	H1278_016_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1278	016	0	1	04	01	H1278_016_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1278	016	0	1	04	01	H1278_016_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	001	0	1	01	01	H1290_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	001	0	1	01	01	H1290_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	001	0	1	01	01	H1290_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	001	0	1	01	01	H1290_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	001	0	1	01	01	H1290_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	002	0	1	01	01	H1290_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	002	0	1	01	01	H1290_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	002	0	1	01	01	H1290_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	002	0	1	01	01	H1290_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	002	0	1	01	01	H1290_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	003	0	1	01	01	H1290_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	003	0	1	01	01	H1290_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	003	0	1	01	01	H1290_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	003	0	1	01	01	H1290_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	003	0	1	01	01	H1290_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	004	0	1	01	01	H1290_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	004	0	1	01	01	H1290_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	004	0	1	01	01	H1290_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	004	0	1	01	01	H1290_004_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	004	0	1	01	01	H1290_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	005	0	1	01	01	H1290_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	005	0	1	01	01	H1290_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	005	0	1	01	01	H1290_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	005	0	1	01	01	H1290_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	005	0	1	01	01	H1290_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	006	0	1	01	01	H1290_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	006	0	1	01	01	H1290_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	006	0	1	01	01	H1290_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	006	0	1	01	01	H1290_006_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	006	0	1	01	01	H1290_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	007	0	1	01	01	H1290_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	007	0	1	01	01	H1290_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	007	0	1	01	01	H1290_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	007	0	1	01	01	H1290_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	007	0	1	01	01	H1290_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	008	0	1	01	01	H1290_008_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	008	0	1	01	01	H1290_008_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	008	0	1	01	01	H1290_008_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	008	0	1	01	01	H1290_008_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	008	0	1	01	01	H1290_008_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	009	0	1	01	01	H1290_009_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	009	0	1	01	01	H1290_009_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	009	0	1	01	01	H1290_009_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	009	0	1	01	01	H1290_009_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	009	0	1	01	01	H1290_009_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	010	0	1	01	01	H1290_010_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	010	0	1	01	01	H1290_010_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	010	0	1	01	01	H1290_010_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	010	0	1	01	01	H1290_010_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	010	0	1	01	01	H1290_010_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	013	0	1	01	01	H1290_013_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	013	0	1	01	01	H1290_013_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	013	0	1	01	01	H1290_013_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	013	0	1	01	01	H1290_013_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	013	0	1	01	01	H1290_013_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	014	0	1	01	01	H1290_014_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	014	0	1	01	01	H1290_014_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	014	0	1	01	01	H1290_014_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	014	0	1	01	01	H1290_014_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	014	0	1	01	01	H1290_014_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	015	0	1	01	01	H1290_015_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	015	0	1	01	01	H1290_015_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	015	0	1	01	01	H1290_015_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	015	0	1	01	01	H1290_015_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	015	0	1	01	01	H1290_015_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	016	0	1	01	01	H1290_016_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	016	0	1	01	01	H1290_016_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	016	0	1	01	01	H1290_016_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	016	0	1	01	01	H1290_016_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	016	0	1	01	01	H1290_016_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	017	0	1	01	01	H1290_017_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	017	0	1	01	01	H1290_017_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	017	0	1	01	01	H1290_017_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	017	0	1	01	01	H1290_017_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	017	0	1	01	01	H1290_017_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	018	0	1	01	01	H1290_018_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	018	0	1	01	01	H1290_018_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	018	0	1	01	01	H1290_018_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	018	0	1	01	01	H1290_018_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	018	0	1	01	01	H1290_018_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	019	0	1	01	01	H1290_019_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	019	0	1	01	01	H1290_019_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	019	0	1	01	01	H1290_019_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	019	0	1	01	01	H1290_019_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	019	0	1	01	01	H1290_019_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	020	0	1	01	01	H1290_020_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	020	0	1	01	01	H1290_020_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	020	0	1	01	01	H1290_020_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	020	0	1	01	01	H1290_020_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	020	0	1	01	01	H1290_020_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	021	0	1	01	01	H1290_021_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	021	0	1	01	01	H1290_021_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	021	0	1	01	01	H1290_021_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	021	0	1	01	01	H1290_021_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	021	0	1	01	01	H1290_021_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	022	0	1	01	01	H1290_022_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	022	0	1	01	01	H1290_022_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	022	0	1	01	01	H1290_022_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	022	0	1	01	01	H1290_022_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	022	0	1	01	01	H1290_022_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	023	0	1	01	01	H1290_023_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	023	0	1	01	01	H1290_023_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	023	0	1	01	01	H1290_023_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	023	0	1	01	01	H1290_023_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	023	0	1	01	01	H1290_023_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	024	0	1	01	01	H1290_024_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	024	0	1	01	01	H1290_024_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	024	0	1	01	01	H1290_024_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	024	0	1	01	01	H1290_024_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	024	0	1	01	01	H1290_024_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	025	0	1	01	01	H1290_025_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	025	0	1	01	01	H1290_025_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	025	0	1	01	01	H1290_025_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	025	0	1	01	01	H1290_025_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	025	0	1	01	01	H1290_025_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	026	0	1	01	01	H1290_026_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	026	0	1	01	01	H1290_026_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	026	0	1	01	01	H1290_026_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	026	0	1	01	01	H1290_026_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	026	0	1	01	01	H1290_026_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	027	0	1	01	01	H1290_027_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	027	0	1	01	01	H1290_027_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	027	0	1	01	01	H1290_027_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	027	0	1	01	01	H1290_027_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	027	0	1	01	01	H1290_027_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	028	0	1	01	01	H1290_028_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	028	0	1	01	01	H1290_028_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	028	0	1	01	01	H1290_028_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	028	0	1	01	01	H1290_028_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	028	0	1	01	01	H1290_028_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	029	0	1	01	01	H1290_029_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	029	0	1	01	01	H1290_029_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	029	0	1	01	01	H1290_029_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	029	0	1	01	01	H1290_029_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	029	0	1	01	01	H1290_029_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	030	0	1	01	01	H1290_030_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	030	0	1	01	01	H1290_030_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	030	0	1	01	01	H1290_030_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	030	0	1	01	01	H1290_030_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	030	0	1	01	01	H1290_030_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	031	0	1	01	01	H1290_031_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	031	0	1	01	01	H1290_031_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	031	0	1	01	01	H1290_031_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	031	0	1	01	01	H1290_031_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	031	0	1	01	01	H1290_031_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1290	032	0	1	01	01	H1290_032_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1290	032	0	1	01	01	H1290_032_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H1290	032	0	1	01	01	H1290_032_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1290	032	0	1	01	01	H1290_032_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1290	032	0	1	01	01	H1290_032_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1304	004	0	1	04	01	H1304_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1304	004	0	1	04	01	H1304_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1304	004	0	1	04	01	H1304_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1304	004	0	1	04	01	H1304_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1304	004	0	1	04	01	H1304_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1304	011	1	1	04	01	H1304_011_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1304	011	1	1	04	01	H1304_011_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1304	011	1	1	04	01	H1304_011_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1304	011	1	1	04	01	H1304_011_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1304	011	1	1	04	01	H1304_011_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1304	011	2	1	04	01	H1304_011_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1304	011	2	1	04	01	H1304_011_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1304	011	2	1	04	01	H1304_011_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1304	011	2	1	04	01	H1304_011_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1304	011	2	1	04	01	H1304_011_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1304	012	1	1	04	01	H1304_012_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1304	012	1	1	04	01	H1304_012_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1304	012	1	1	04	01	H1304_012_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1304	012	1	1	04	01	H1304_012_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1304	012	1	1	04	01	H1304_012_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1304	012	2	1	04	01	H1304_012_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1304	012	2	1	04	01	H1304_012_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1304	012	2	1	04	01	H1304_012_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1304	012	2	1	04	01	H1304_012_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1304	012	2	1	04	01	H1304_012_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1350	015	1	1	01	01	H1350_015_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1350	015	1	1	01	01	H1350_015_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1350	015	1	1	01	01	H1350_015_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1350	015	1	1	01	01	H1350_015_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H1350	015	1	1	01	01	H1350_015_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1350	015	2	1	01	01	H1350_015_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1350	015	2	1	01	01	H1350_015_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1350	015	2	1	01	01	H1350_015_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1350	015	2	1	01	01	H1350_015_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H1350	015	2	1	01	01	H1350_015_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1350	016	1	1	01	01	H1350_016_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1350	016	1	1	01	01	H1350_016_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1350	016	1	1	01	01	H1350_016_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1350	016	1	1	01	01	H1350_016_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H1350	016	1	1	01	01	H1350_016_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1350	016	2	1	01	01	H1350_016_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1350	016	2	1	01	01	H1350_016_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1350	016	2	1	01	01	H1350_016_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1350	016	2	1	01	01	H1350_016_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H1350	016	2	1	01	01	H1350_016_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1350	019	1	1	01	01	H1350_019_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1350	019	1	1	01	01	H1350_019_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1350	019	1	1	01	01	H1350_019_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1350	019	1	1	01	01	H1350_019_1	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1350	019	1	1	01	01	H1350_019_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1350	019	2	1	01	01	H1350_019_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1350	019	2	1	01	01	H1350_019_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1350	019	2	1	01	01	H1350_019_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1350	019	2	1	01	01	H1350_019_2	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1350	019	2	1	01	01	H1350_019_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1350	021	0	1	01	01	H1350_021_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1350	021	0	1	01	01	H1350_021_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1350	021	0	1	01	01	H1350_021_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1350	021	0	1	01	01	H1350_021_0	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1350	021	0	1	01	01	H1350_021_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1350	023	1	1	01	01	H1350_023_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1350	023	1	1	01	01	H1350_023_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1350	023	1	1	01	01	H1350_023_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1350	023	1	1	01	01	H1350_023_1	2	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1350	023	1	1	01	01	H1350_023_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1350	023	2	1	01	01	H1350_023_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1350	023	2	1	01	01	H1350_023_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1350	023	2	1	01	01	H1350_023_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1350	023	2	1	01	01	H1350_023_2	2	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1350	023	2	1	01	01	H1350_023_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1350	024	1	1	01	01	H1350_024_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1350	024	1	1	01	01	H1350_024_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1350	024	1	1	01	01	H1350_024_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1350	024	1	1	01	01	H1350_024_1	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1350	024	1	1	01	01	H1350_024_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1350	024	2	1	01	01	H1350_024_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1350	024	2	1	01	01	H1350_024_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1350	024	2	1	01	01	H1350_024_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1350	024	2	1	01	01	H1350_024_2	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1350	024	2	1	01	01	H1350_024_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1350	024	3	1	01	01	H1350_024_3	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1350	024	3	1	01	01	H1350_024_3	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1350	024	3	1	01	01	H1350_024_3	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1350	024	3	1	01	01	H1350_024_3	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1350	024	3	1	01	01	H1350_024_3	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1350	026	0	1	01	01	H1350_026_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1350	026	0	1	01	01	H1350_026_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1350	026	0	1	01	01	H1350_026_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1350	026	0	1	01	01	H1350_026_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1350	026	0	1	01	01	H1350_026_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1352	001	0	1	01	01	H1352_001_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1352	001	0	1	01	01	H1352_001_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1352	001	0	1	01	01	H1352_001_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1352	001	0	1	01	01	H1352_001_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1352	001	0	1	01	01	H1352_001_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1352	002	0	1	01	01	H1352_002_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1352	002	0	1	01	01	H1352_002_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1352	002	0	1	01	01	H1352_002_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1352	002	0	1	01	01	H1352_002_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1352	002	0	1	01	01	H1352_002_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1352	003	0	1	01	01	H1352_003_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1352	003	0	1	01	01	H1352_003_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1352	003	0	1	01	01	H1352_003_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1352	003	0	1	01	01	H1352_003_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1352	003	0	1	01	01	H1352_003_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1353	001	0	1	01	01	H1353_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1353	001	0	1	01	01	H1353_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1353	001	0	1	01	01	H1353_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1353	001	0	1	01	01	H1353_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1353	001	0	1	01	01	H1353_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1353	002	0	1	01	01	H1353_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1353	002	0	1	01	01	H1353_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1353	002	0	1	01	01	H1353_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1353	002	0	1	01	01	H1353_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1353	002	0	1	01	01	H1353_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1353	004	0	1	01	01	H1353_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1353	004	0	1	01	01	H1353_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1353	004	0	1	01	01	H1353_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1353	004	0	1	01	01	H1353_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1353	004	0	1	01	01	H1353_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1353	005	0	1	01	01	H1353_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1353	005	0	1	01	01	H1353_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1353	005	0	1	01	01	H1353_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1353	005	0	1	01	01	H1353_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1353	005	0	1	01	01	H1353_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1353	006	0	1	01	01	H1353_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1353	006	0	1	01	01	H1353_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1353	006	0	1	01	01	H1353_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1353	006	0	1	01	01	H1353_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1353	006	0	1	01	01	H1353_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1365	001	0	1	04	01	H1365_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1365	001	0	1	04	01	H1365_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1365	001	0	1	04	01	H1365_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1365	001	0	1	04	01	H1365_001_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1365	001	0	1	04	01	H1365_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H1365	002	0	1	04	01	H1365_002_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1365	002	0	1	04	01	H1365_002_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1365	002	0	1	04	01	H1365_002_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1365	002	0	1	04	01	H1365_002_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1365	002	0	1	04	01	H1365_002_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H1393	001	0	1	04	01	H1393_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1393	001	0	1	04	01	H1393_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1393	001	0	1	04	01	H1393_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1393	001	0	1	04	01	H1393_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1393	001	0	1	04	01	H1393_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1393	001	0	1	04	01	H1393_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H1393	002	0	1	04	01	H1393_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1393	002	0	1	04	01	H1393_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1393	002	0	1	04	01	H1393_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1393	002	0	1	04	01	H1393_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1393	002	0	1	04	01	H1393_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1393	002	0	1	04	01	H1393_002_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H1393	003	0	1	04	01	H1393_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1393	003	0	1	04	01	H1393_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1393	003	0	1	04	01	H1393_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1393	003	0	1	04	01	H1393_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1393	003	0	1	04	01	H1393_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1393	003	0	1	04	01	H1393_003_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H1393	004	0	1	04	01	H1393_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1393	004	0	1	04	01	H1393_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1393	004	0	1	04	01	H1393_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1393	004	0	1	04	01	H1393_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1393	004	0	1	04	01	H1393_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1393	004	0	1	04	01	H1393_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H1415	021	0	1	02	01	H1415_021_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1415	021	0	1	02	01	H1415_021_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1415	021	0	1	02	01	H1415_021_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1415	021	0	1	02	01	H1415_021_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1415	021	0	1	02	01	H1415_021_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1415	024	0	1	01	01	H1415_024_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1415	024	0	1	01	01	H1415_024_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1415	024	0	1	01	01	H1415_024_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1415	024	0	1	01	01	H1415_024_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1415	024	0	1	01	01	H1415_024_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	009	0	1	02	01	H1416_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	009	0	1	02	01	H1416_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	009	0	1	02	01	H1416_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	009	0	1	02	01	H1416_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	009	0	1	02	01	H1416_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	023	0	1	01	01	H1416_023_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	023	0	1	01	01	H1416_023_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	023	0	1	01	01	H1416_023_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	023	0	1	01	01	H1416_023_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	023	0	1	01	01	H1416_023_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	026	0	1	02	01	H1416_026_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	026	0	1	02	01	H1416_026_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	026	0	1	02	01	H1416_026_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	026	0	1	02	01	H1416_026_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	026	0	1	02	01	H1416_026_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	033	0	1	02	01	H1416_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	033	0	1	02	01	H1416_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	033	0	1	02	01	H1416_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	033	0	1	02	01	H1416_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	033	0	1	02	01	H1416_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	034	0	1	01	01	H1416_034_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	034	0	1	01	01	H1416_034_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	034	0	1	01	01	H1416_034_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	034	0	1	01	01	H1416_034_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	034	0	1	01	01	H1416_034_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	035	0	1	01	01	H1416_035_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	035	0	1	01	01	H1416_035_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	035	0	1	01	01	H1416_035_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	035	0	1	01	01	H1416_035_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	035	0	1	01	01	H1416_035_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	036	0	1	01	01	H1416_036_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	036	0	1	01	01	H1416_036_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	036	0	1	01	01	H1416_036_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	036	0	1	01	01	H1416_036_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	036	0	1	01	01	H1416_036_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	039	0	1	01	01	H1416_039_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	039	0	1	01	01	H1416_039_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	039	0	1	01	01	H1416_039_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	039	0	1	01	01	H1416_039_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	039	0	1	01	01	H1416_039_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	041	0	1	01	01	H1416_041_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	041	0	1	01	01	H1416_041_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	041	0	1	01	01	H1416_041_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	041	0	1	01	01	H1416_041_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	041	0	1	01	01	H1416_041_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	042	0	1	01	01	H1416_042_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	042	0	1	01	01	H1416_042_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	042	0	1	01	01	H1416_042_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	042	0	1	01	01	H1416_042_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	042	0	1	01	01	H1416_042_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	043	0	1	02	01	H1416_043_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	043	0	1	02	01	H1416_043_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	043	0	1	02	01	H1416_043_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	043	0	1	02	01	H1416_043_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	043	0	1	02	01	H1416_043_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	044	0	1	01	01	H1416_044_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	044	0	1	01	01	H1416_044_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	044	0	1	01	01	H1416_044_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	044	0	1	01	01	H1416_044_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	044	0	1	01	01	H1416_044_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	048	0	1	01	01	H1416_048_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	048	0	1	01	01	H1416_048_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	048	0	1	01	01	H1416_048_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	048	0	1	01	01	H1416_048_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	048	0	1	01	01	H1416_048_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	055	0	1	01	01	H1416_055_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	055	0	1	01	01	H1416_055_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	055	0	1	01	01	H1416_055_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	055	0	1	01	01	H1416_055_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	055	0	1	01	01	H1416_055_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	056	0	1	01	01	H1416_056_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	056	0	1	01	01	H1416_056_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	056	0	1	01	01	H1416_056_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	056	0	1	01	01	H1416_056_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	056	0	1	01	01	H1416_056_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	057	0	1	01	01	H1416_057_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	057	0	1	01	01	H1416_057_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	057	0	1	01	01	H1416_057_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	057	0	1	01	01	H1416_057_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	057	0	1	01	01	H1416_057_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	064	0	1	01	01	H1416_064_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	064	0	1	01	01	H1416_064_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	064	0	1	01	01	H1416_064_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	064	0	1	01	01	H1416_064_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	064	0	1	01	01	H1416_064_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	065	0	1	01	01	H1416_065_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	065	0	1	01	01	H1416_065_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	065	0	1	01	01	H1416_065_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	065	0	1	01	01	H1416_065_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	065	0	1	01	01	H1416_065_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	066	0	1	01	01	H1416_066_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H1416	066	0	1	01	01	H1416_066_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1416	066	0	1	01	01	H1416_066_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1416	066	0	1	01	01	H1416_066_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1416	066	0	1	01	01	H1416_066_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1416	066	0	1	01	01	H1416_066_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1416	067	1	1	01	01	H1416_067_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	067	1	1	01	01	H1416_067_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	067	1	1	01	01	H1416_067_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	067	1	1	01	01	H1416_067_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	067	1	1	01	01	H1416_067_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	067	2	1	01	01	H1416_067_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	067	2	1	01	01	H1416_067_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	067	2	1	01	01	H1416_067_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	067	2	1	01	01	H1416_067_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	067	2	1	01	01	H1416_067_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	068	0	1	01	01	H1416_068_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	068	0	1	01	01	H1416_068_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	068	0	1	01	01	H1416_068_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	068	0	1	01	01	H1416_068_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	068	0	1	01	01	H1416_068_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	069	1	1	02	01	H1416_069_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	069	1	1	02	01	H1416_069_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	069	1	1	02	01	H1416_069_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	069	1	1	02	01	H1416_069_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	069	1	1	02	01	H1416_069_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	069	2	1	02	01	H1416_069_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	069	2	1	02	01	H1416_069_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	069	2	1	02	01	H1416_069_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	069	2	1	02	01	H1416_069_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	069	2	1	02	01	H1416_069_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1416	069	3	1	02	01	H1416_069_3	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1416	069	3	1	02	01	H1416_069_3	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1416	069	3	1	02	01	H1416_069_3	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1416	069	3	1	02	01	H1416_069_3	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1416	069	3	1	02	01	H1416_069_3	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1423	001	0	1	01	01	H1423_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H1423	001	0	1	01	01	H1423_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H1423	001	0	1	01	01	H1423_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H1423	001	0	1	01	01	H1423_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H1423	001	0	1	01	01	H1423_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H1423	001	0	1	01	01	H1423_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H1423	002	0	1	01	01	H1423_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H1423	002	0	1	01	01	H1423_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H1423	002	0	1	01	01	H1423_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H1423	002	0	1	01	01	H1423_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H1423	002	0	1	01	01	H1423_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H1423	002	0	1	01	01	H1423_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H1423	003	0	1	01	01	H1423_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H1423	003	0	1	01	01	H1423_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H1423	003	0	1	01	01	H1423_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H1423	003	0	1	01	01	H1423_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H1423	003	0	1	01	01	H1423_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H1423	003	0	1	01	01	H1423_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H1423	004	0	1	01	01	H1423_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H1423	004	0	1	01	01	H1423_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H1423	004	0	1	01	01	H1423_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H1423	004	0	1	01	01	H1423_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H1423	004	0	1	01	01	H1423_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H1423	004	0	1	01	01	H1423_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H1423	005	0	1	01	01	H1423_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H1423	005	0	1	01	01	H1423_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H1423	005	0	1	01	01	H1423_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H1423	005	0	1	01	01	H1423_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H1423	005	0	1	01	01	H1423_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H1423	005	0	1	01	01	H1423_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H1423	007	0	1	01	01	H1423_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H1423	007	0	1	01	01	H1423_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H1423	007	0	1	01	01	H1423_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H1423	007	0	1	01	01	H1423_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H1423	007	0	1	01	01	H1423_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H1423	007	0	1	01	01	H1423_007_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H1423	008	0	1	01	01	H1423_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H1423	008	0	1	01	01	H1423_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H1423	008	0	1	01	01	H1423_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H1423	008	0	1	01	01	H1423_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H1423	008	0	1	01	01	H1423_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H1423	008	0	1	01	01	H1423_008_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H1426	001	0	1	01	01	H1426_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1426	001	0	1	01	01	H1426_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1426	001	0	1	01	01	H1426_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1426	001	0	1	01	01	H1426_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1426	001	0	1	01	01	H1426_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1426	002	0	1	01	01	H1426_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1426	002	0	1	01	01	H1426_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1426	002	0	1	01	01	H1426_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1426	002	0	1	01	01	H1426_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1426	002	0	1	01	01	H1426_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1426	003	0	1	01	01	H1426_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1426	003	0	1	01	01	H1426_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1426	003	0	1	01	01	H1426_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1426	003	0	1	01	01	H1426_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1426	003	0	1	01	01	H1426_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1436	002	0	1	01	01	H1436_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1436	002	0	1	01	01	H1436_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1436	002	0	1	01	01	H1436_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1436	002	0	1	01	01	H1436_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1436	002	0	1	01	01	H1436_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1436	002	0	1	01	01	H1436_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1436	004	0	1	01	01	H1436_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1436	004	0	1	01	01	H1436_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1436	004	0	1	01	01	H1436_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1436	004	0	1	01	01	H1436_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1436	004	0	1	01	01	H1436_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1436	004	0	1	01	01	H1436_004_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1436	005	0	1	01	01	H1436_005_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1436	005	0	1	01	01	H1436_005_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1436	005	0	1	01	01	H1436_005_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1436	005	0	1	01	01	H1436_005_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1436	005	0	1	01	01	H1436_005_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	003	0	1	01	01	H1463_003_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	003	0	1	01	01	H1463_003_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	003	0	1	01	01	H1463_003_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	003	0	1	01	01	H1463_003_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	003	0	1	01	01	H1463_003_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	009	0	1	01	01	H1463_009_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	009	0	1	01	01	H1463_009_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	009	0	1	01	01	H1463_009_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	009	0	1	01	01	H1463_009_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	009	0	1	01	01	H1463_009_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	010	0	1	01	01	H1463_010_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	010	0	1	01	01	H1463_010_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	010	0	1	01	01	H1463_010_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	010	0	1	01	01	H1463_010_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	010	0	1	01	01	H1463_010_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	012	0	1	01	01	H1463_012_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	012	0	1	01	01	H1463_012_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	012	0	1	01	01	H1463_012_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	012	0	1	01	01	H1463_012_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	012	0	1	01	01	H1463_012_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	013	0	1	01	01	H1463_013_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	013	0	1	01	01	H1463_013_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	013	0	1	01	01	H1463_013_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	013	0	1	01	01	H1463_013_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	013	0	1	01	01	H1463_013_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	015	0	1	02	01	H1463_015_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	015	0	1	02	01	H1463_015_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	015	0	1	02	01	H1463_015_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	015	0	1	02	01	H1463_015_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	015	0	1	02	01	H1463_015_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	017	0	1	02	01	H1463_017_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	017	0	1	02	01	H1463_017_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	017	0	1	02	01	H1463_017_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	017	0	1	02	01	H1463_017_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	017	0	1	02	01	H1463_017_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	019	0	1	02	01	H1463_019_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	019	0	1	02	01	H1463_019_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	019	0	1	02	01	H1463_019_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	019	0	1	02	01	H1463_019_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	019	0	1	02	01	H1463_019_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	021	0	1	01	01	H1463_021_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	021	0	1	01	01	H1463_021_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	021	0	1	01	01	H1463_021_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	021	0	1	01	01	H1463_021_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	021	0	1	01	01	H1463_021_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	022	0	1	02	01	H1463_022_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	022	0	1	02	01	H1463_022_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	022	0	1	02	01	H1463_022_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	022	0	1	02	01	H1463_022_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	022	0	1	02	01	H1463_022_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	023	0	1	01	01	H1463_023_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	023	0	1	01	01	H1463_023_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	023	0	1	01	01	H1463_023_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	023	0	1	01	01	H1463_023_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	023	0	1	01	01	H1463_023_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	024	0	1	01	01	H1463_024_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	024	0	1	01	01	H1463_024_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	024	0	1	01	01	H1463_024_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	024	0	1	01	01	H1463_024_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	024	0	1	01	01	H1463_024_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	025	0	1	02	01	H1463_025_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	025	0	1	02	01	H1463_025_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	025	0	1	02	01	H1463_025_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	025	0	1	02	01	H1463_025_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	025	0	1	02	01	H1463_025_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	032	0	1	01	01	H1463_032_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	032	0	1	01	01	H1463_032_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	032	0	1	01	01	H1463_032_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	032	0	1	01	01	H1463_032_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	032	0	1	01	01	H1463_032_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	033	0	1	01	01	H1463_033_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	033	0	1	01	01	H1463_033_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	033	0	1	01	01	H1463_033_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	033	0	1	01	01	H1463_033_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	033	0	1	01	01	H1463_033_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	034	0	1	02	01	H1463_034_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	034	0	1	02	01	H1463_034_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	034	0	1	02	01	H1463_034_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	034	0	1	02	01	H1463_034_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	034	0	1	02	01	H1463_034_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	035	0	1	01	01	H1463_035_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	035	0	1	01	01	H1463_035_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	035	0	1	01	01	H1463_035_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	035	0	1	01	01	H1463_035_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	035	0	1	01	01	H1463_035_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	036	0	1	02	01	H1463_036_0	14	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	036	0	1	02	01	H1463_036_0	14	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	036	0	1	02	01	H1463_036_0	14	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	036	0	1	02	01	H1463_036_0	14	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	036	0	1	02	01	H1463_036_0	14	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	037	0	1	02	01	H1463_037_0	14	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	037	0	1	02	01	H1463_037_0	14	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	037	0	1	02	01	H1463_037_0	14	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	037	0	1	02	01	H1463_037_0	14	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	037	0	1	02	01	H1463_037_0	14	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	038	0	1	01	01	H1463_038_0	14	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	038	0	1	01	01	H1463_038_0	14	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	038	0	1	01	01	H1463_038_0	14	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	038	0	1	01	01	H1463_038_0	14	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	038	0	1	01	01	H1463_038_0	14	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	039	0	1	01	01	H1463_039_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	039	0	1	01	01	H1463_039_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	039	0	1	01	01	H1463_039_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	039	0	1	01	01	H1463_039_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	039	0	1	01	01	H1463_039_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	040	0	1	02	01	H1463_040_0	15	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	040	0	1	02	01	H1463_040_0	15	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	040	0	1	02	01	H1463_040_0	15	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	040	0	1	02	01	H1463_040_0	15	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	040	0	1	02	01	H1463_040_0	15	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1463	041	0	1	01	01	H1463_041_0	14	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1463	041	0	1	01	01	H1463_041_0	14	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1463	041	0	1	01	01	H1463_041_0	14	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1463	041	0	1	01	01	H1463_041_0	14	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1463	041	0	1	01	01	H1463_041_0	14	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1468	007	0	1	01	01	H1468_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1468	007	0	1	01	01	H1468_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1468	007	0	1	01	01	H1468_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1468	007	0	1	01	01	H1468_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1468	007	0	1	01	01	H1468_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1468	013	0	1	01	01	H1468_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1468	013	0	1	01	01	H1468_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1468	013	0	1	01	01	H1468_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1468	013	0	1	01	01	H1468_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1468	013	0	1	01	01	H1468_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1468	014	0	1	01	01	H1468_014_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1468	014	0	1	01	01	H1468_014_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1468	014	0	1	01	01	H1468_014_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1468	014	0	1	01	01	H1468_014_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1468	014	0	1	01	01	H1468_014_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1468	017	0	1	01	01	H1468_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1468	017	0	1	01	01	H1468_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H1468	017	0	1	01	01	H1468_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1468	017	0	1	01	01	H1468_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1468	017	0	1	01	01	H1468_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1468	017	0	1	01	01	H1468_017_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1468	018	0	1	01	01	H1468_018_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1468	018	0	1	01	01	H1468_018_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1468	018	0	1	01	01	H1468_018_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1468	018	0	1	01	01	H1468_018_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1468	018	0	1	01	01	H1468_018_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1537	005	0	1	04	01	H1537_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1537	005	0	1	04	01	H1537_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1537	005	0	1	04	01	H1537_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1537	005	0	1	04	01	H1537_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1537	005	0	1	04	01	H1537_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1607	012	0	1	04	01	H1607_012_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1607	012	0	1	04	01	H1607_012_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1607	012	0	1	04	01	H1607_012_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1607	012	0	1	04	01	H1607_012_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1607	012	0	1	04	01	H1607_012_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1607	012	0	1	04	01	H1607_012_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1607	014	0	1	04	01	H1607_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1607	014	0	1	04	01	H1607_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1607	014	0	1	04	01	H1607_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1607	014	0	1	04	01	H1607_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1607	014	0	1	04	01	H1607_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1607	014	0	1	04	01	H1607_014_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1607	015	0	1	04	01	H1607_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1607	015	0	1	04	01	H1607_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1607	015	0	1	04	01	H1607_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1607	015	0	1	04	01	H1607_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1607	015	0	1	04	01	H1607_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1607	015	0	1	04	01	H1607_015_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1608	001	0	1	04	01	H1608_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	001	0	1	04	01	H1608_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	001	0	1	04	01	H1608_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	001	0	1	04	01	H1608_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	001	0	1	04	01	H1608_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	004	0	1	04	01	H1608_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	004	0	1	04	01	H1608_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	004	0	1	04	01	H1608_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	004	0	1	04	01	H1608_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	004	0	1	04	01	H1608_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	007	0	1	04	01	H1608_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	007	0	1	04	01	H1608_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	007	0	1	04	01	H1608_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	007	0	1	04	01	H1608_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	007	0	1	04	01	H1608_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	008	0	1	04	01	H1608_008_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	008	0	1	04	01	H1608_008_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	008	0	1	04	01	H1608_008_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	008	0	1	04	01	H1608_008_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	008	0	1	04	01	H1608_008_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	012	0	1	04	01	H1608_012_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	012	0	1	04	01	H1608_012_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	012	0	1	04	01	H1608_012_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	012	0	1	04	01	H1608_012_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	012	0	1	04	01	H1608_012_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	013	0	1	04	01	H1608_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	013	0	1	04	01	H1608_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	013	0	1	04	01	H1608_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	013	0	1	04	01	H1608_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	013	0	1	04	01	H1608_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	016	0	1	04	01	H1608_016_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	016	0	1	04	01	H1608_016_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	016	0	1	04	01	H1608_016_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	016	0	1	04	01	H1608_016_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	016	0	1	04	01	H1608_016_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	017	0	1	04	01	H1608_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	017	0	1	04	01	H1608_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	017	0	1	04	01	H1608_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	017	0	1	04	01	H1608_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	017	0	1	04	01	H1608_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	018	0	1	04	01	H1608_018_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	018	0	1	04	01	H1608_018_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	018	0	1	04	01	H1608_018_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	018	0	1	04	01	H1608_018_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	018	0	1	04	01	H1608_018_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	021	0	1	04	01	H1608_021_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	021	0	1	04	01	H1608_021_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	021	0	1	04	01	H1608_021_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	021	0	1	04	01	H1608_021_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	021	0	1	04	01	H1608_021_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	024	0	1	04	01	H1608_024_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	024	0	1	04	01	H1608_024_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	024	0	1	04	01	H1608_024_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	024	0	1	04	01	H1608_024_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	024	0	1	04	01	H1608_024_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	026	0	1	04	01	H1608_026_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1608	026	0	1	04	01	H1608_026_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1608	026	0	1	04	01	H1608_026_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	026	0	1	04	01	H1608_026_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	026	0	1	04	01	H1608_026_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	027	0	1	04	01	H1608_027_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1608	027	0	1	04	01	H1608_027_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1608	027	0	1	04	01	H1608_027_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	027	0	1	04	01	H1608_027_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	027	0	1	04	01	H1608_027_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	028	0	1	04	01	H1608_028_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	028	0	1	04	01	H1608_028_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	028	0	1	04	01	H1608_028_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	028	0	1	04	01	H1608_028_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	028	0	1	04	01	H1608_028_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	029	0	1	04	01	H1608_029_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	029	0	1	04	01	H1608_029_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	029	0	1	04	01	H1608_029_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	029	0	1	04	01	H1608_029_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	029	0	1	04	01	H1608_029_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	031	0	1	04	01	H1608_031_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	031	0	1	04	01	H1608_031_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	031	0	1	04	01	H1608_031_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	031	0	1	04	01	H1608_031_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	031	0	1	04	01	H1608_031_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	035	0	1	04	01	H1608_035_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	035	0	1	04	01	H1608_035_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	035	0	1	04	01	H1608_035_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	035	0	1	04	01	H1608_035_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	035	0	1	04	01	H1608_035_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	037	0	1	04	01	H1608_037_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	037	0	1	04	01	H1608_037_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	037	0	1	04	01	H1608_037_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	037	0	1	04	01	H1608_037_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	037	0	1	04	01	H1608_037_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	038	0	1	04	01	H1608_038_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	038	0	1	04	01	H1608_038_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	038	0	1	04	01	H1608_038_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	038	0	1	04	01	H1608_038_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	038	0	1	04	01	H1608_038_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	039	0	1	04	01	H1608_039_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	039	0	1	04	01	H1608_039_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	039	0	1	04	01	H1608_039_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	039	0	1	04	01	H1608_039_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	039	0	1	04	01	H1608_039_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	040	0	1	04	01	H1608_040_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	040	0	1	04	01	H1608_040_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	040	0	1	04	01	H1608_040_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	040	0	1	04	01	H1608_040_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	040	0	1	04	01	H1608_040_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	041	0	1	04	01	H1608_041_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	041	0	1	04	01	H1608_041_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	041	0	1	04	01	H1608_041_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	041	0	1	04	01	H1608_041_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	041	0	1	04	01	H1608_041_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	043	0	1	04	01	H1608_043_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	043	0	1	04	01	H1608_043_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	043	0	1	04	01	H1608_043_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	043	0	1	04	01	H1608_043_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	043	0	1	04	01	H1608_043_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	047	0	1	04	01	H1608_047_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	047	0	1	04	01	H1608_047_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	047	0	1	04	01	H1608_047_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	047	0	1	04	01	H1608_047_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	047	0	1	04	01	H1608_047_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	048	0	1	04	01	H1608_048_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	048	0	1	04	01	H1608_048_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	048	0	1	04	01	H1608_048_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	048	0	1	04	01	H1608_048_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	048	0	1	04	01	H1608_048_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	050	0	1	04	01	H1608_050_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	050	0	1	04	01	H1608_050_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	050	0	1	04	01	H1608_050_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	050	0	1	04	01	H1608_050_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	050	0	1	04	01	H1608_050_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	051	0	1	04	01	H1608_051_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	051	0	1	04	01	H1608_051_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	051	0	1	04	01	H1608_051_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	051	0	1	04	01	H1608_051_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	051	0	1	04	01	H1608_051_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	052	0	1	04	01	H1608_052_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	052	0	1	04	01	H1608_052_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	052	0	1	04	01	H1608_052_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	052	0	1	04	01	H1608_052_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	052	0	1	04	01	H1608_052_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	053	0	1	04	01	H1608_053_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	053	0	1	04	01	H1608_053_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	053	0	1	04	01	H1608_053_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	053	0	1	04	01	H1608_053_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	053	0	1	04	01	H1608_053_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	054	0	1	04	01	H1608_054_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	054	0	1	04	01	H1608_054_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	054	0	1	04	01	H1608_054_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	054	0	1	04	01	H1608_054_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	054	0	1	04	01	H1608_054_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	055	0	1	04	01	H1608_055_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	055	0	1	04	01	H1608_055_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	055	0	1	04	01	H1608_055_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	055	0	1	04	01	H1608_055_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	055	0	1	04	01	H1608_055_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	056	0	1	04	01	H1608_056_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	056	0	1	04	01	H1608_056_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	056	0	1	04	01	H1608_056_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	056	0	1	04	01	H1608_056_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	056	0	1	04	01	H1608_056_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1608	059	0	1	04	01	H1608_059_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1608	059	0	1	04	01	H1608_059_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1608	059	0	1	04	01	H1608_059_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1608	059	0	1	04	01	H1608_059_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1608	059	0	1	04	01	H1608_059_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	001	0	1	01	01	H1609_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1609	001	0	1	01	01	H1609_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1609	001	0	1	01	01	H1609_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	001	0	1	01	01	H1609_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	001	0	1	01	01	H1609_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	009	0	1	01	01	H1609_009_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1609	009	0	1	01	01	H1609_009_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1609	009	0	1	01	01	H1609_009_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	009	0	1	01	01	H1609_009_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	009	0	1	01	01	H1609_009_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	016	0	1	01	01	H1609_016_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	016	0	1	01	01	H1609_016_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	016	0	1	01	01	H1609_016_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	016	0	1	01	01	H1609_016_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	016	0	1	01	01	H1609_016_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	017	0	1	01	01	H1609_017_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	017	0	1	01	01	H1609_017_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	017	0	1	01	01	H1609_017_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	017	0	1	01	01	H1609_017_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	017	0	1	01	01	H1609_017_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	018	0	1	01	01	H1609_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	018	0	1	01	01	H1609_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	018	0	1	01	01	H1609_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	018	0	1	01	01	H1609_018_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	018	0	1	01	01	H1609_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	019	0	1	01	01	H1609_019_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	019	0	1	01	01	H1609_019_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	019	0	1	01	01	H1609_019_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	019	0	1	01	01	H1609_019_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	019	0	1	01	01	H1609_019_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	020	0	1	01	01	H1609_020_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	020	0	1	01	01	H1609_020_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	020	0	1	01	01	H1609_020_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	020	0	1	01	01	H1609_020_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	020	0	1	01	01	H1609_020_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	021	0	1	01	01	H1609_021_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	021	0	1	01	01	H1609_021_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	021	0	1	01	01	H1609_021_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	021	0	1	01	01	H1609_021_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	021	0	1	01	01	H1609_021_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	022	0	1	01	01	H1609_022_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	022	0	1	01	01	H1609_022_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	022	0	1	01	01	H1609_022_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	022	0	1	01	01	H1609_022_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	022	0	1	01	01	H1609_022_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	023	0	1	01	01	H1609_023_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	023	0	1	01	01	H1609_023_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	023	0	1	01	01	H1609_023_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	023	0	1	01	01	H1609_023_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	023	0	1	01	01	H1609_023_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	025	0	1	01	01	H1609_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	025	0	1	01	01	H1609_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	025	0	1	01	01	H1609_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	025	0	1	01	01	H1609_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	025	0	1	01	01	H1609_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	026	0	1	01	01	H1609_026_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	026	0	1	01	01	H1609_026_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	026	0	1	01	01	H1609_026_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	026	0	1	01	01	H1609_026_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	026	0	1	01	01	H1609_026_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	027	0	1	01	01	H1609_027_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	027	0	1	01	01	H1609_027_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	027	0	1	01	01	H1609_027_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	027	0	1	01	01	H1609_027_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	027	0	1	01	01	H1609_027_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	028	0	1	02	01	H1609_028_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1609	028	0	1	02	01	H1609_028_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1609	028	0	1	02	01	H1609_028_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	028	0	1	02	01	H1609_028_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	028	0	1	02	01	H1609_028_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	034	0	1	01	01	H1609_034_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	034	0	1	01	01	H1609_034_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	034	0	1	01	01	H1609_034_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	034	0	1	01	01	H1609_034_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	034	0	1	01	01	H1609_034_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	035	0	1	01	01	H1609_035_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	035	0	1	01	01	H1609_035_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	035	0	1	01	01	H1609_035_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	035	0	1	01	01	H1609_035_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	035	0	1	01	01	H1609_035_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	037	0	1	01	01	H1609_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	037	0	1	01	01	H1609_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	037	0	1	01	01	H1609_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	037	0	1	01	01	H1609_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	037	0	1	01	01	H1609_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	038	0	1	01	01	H1609_038_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	038	0	1	01	01	H1609_038_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	038	0	1	01	01	H1609_038_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	038	0	1	01	01	H1609_038_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	038	0	1	01	01	H1609_038_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	039	0	1	01	01	H1609_039_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	039	0	1	01	01	H1609_039_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	039	0	1	01	01	H1609_039_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	039	0	1	01	01	H1609_039_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	039	0	1	01	01	H1609_039_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	040	0	1	01	01	H1609_040_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	040	0	1	01	01	H1609_040_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	040	0	1	01	01	H1609_040_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	040	0	1	01	01	H1609_040_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	040	0	1	01	01	H1609_040_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	041	0	1	01	01	H1609_041_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	041	0	1	01	01	H1609_041_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	041	0	1	01	01	H1609_041_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	041	0	1	01	01	H1609_041_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	041	0	1	01	01	H1609_041_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	042	0	1	01	01	H1609_042_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	042	0	1	01	01	H1609_042_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	042	0	1	01	01	H1609_042_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	042	0	1	01	01	H1609_042_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	042	0	1	01	01	H1609_042_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	043	0	1	01	01	H1609_043_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	043	0	1	01	01	H1609_043_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	043	0	1	01	01	H1609_043_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	043	0	1	01	01	H1609_043_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	043	0	1	01	01	H1609_043_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	044	0	1	01	01	H1609_044_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	044	0	1	01	01	H1609_044_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	044	0	1	01	01	H1609_044_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	044	0	1	01	01	H1609_044_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	044	0	1	01	01	H1609_044_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	045	0	1	01	01	H1609_045_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	045	0	1	01	01	H1609_045_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	045	0	1	01	01	H1609_045_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	045	0	1	01	01	H1609_045_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	045	0	1	01	01	H1609_045_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	046	0	1	01	01	H1609_046_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	046	0	1	01	01	H1609_046_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	046	0	1	01	01	H1609_046_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	046	0	1	01	01	H1609_046_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	046	0	1	01	01	H1609_046_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	047	0	1	01	01	H1609_047_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	047	0	1	01	01	H1609_047_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	047	0	1	01	01	H1609_047_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	047	0	1	01	01	H1609_047_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	047	0	1	01	01	H1609_047_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	048	0	1	01	01	H1609_048_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	048	0	1	01	01	H1609_048_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	048	0	1	01	01	H1609_048_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	048	0	1	01	01	H1609_048_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	048	0	1	01	01	H1609_048_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	049	0	1	01	01	H1609_049_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H1609	049	0	1	01	01	H1609_049_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1609	049	0	1	01	01	H1609_049_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	049	0	1	01	01	H1609_049_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	049	0	1	01	01	H1609_049_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1609	053	0	1	01	01	H1609_053_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1609	053	0	1	01	01	H1609_053_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1609	053	0	1	01	01	H1609_053_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1609	053	0	1	01	01	H1609_053_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1609	053	0	1	01	01	H1609_053_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1610	001	0	1	01	01	H1610_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1610	001	0	1	01	01	H1610_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1610	001	0	1	01	01	H1610_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1610	001	0	1	01	01	H1610_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1610	001	0	1	01	01	H1610_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1659	002	0	1	04	01	H1659_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1659	002	0	1	04	01	H1659_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1659	002	0	1	04	01	H1659_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1659	002	0	1	04	01	H1659_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1659	002	0	1	04	01	H1659_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1659	003	0	1	04	01	H1659_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1659	003	0	1	04	01	H1659_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1659	003	0	1	04	01	H1659_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1659	003	0	1	04	01	H1659_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1659	003	0	1	04	01	H1659_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1660	013	0	1	01	01	H1660_013_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H1660	013	0	1	01	01	H1660_013_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H1660	013	0	1	01	01	H1660_013_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1660	013	0	1	01	01	H1660_013_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1660	013	0	1	01	01	H1660_013_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1660	014	0	1	01	01	H1660_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H1660	014	0	1	01	01	H1660_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H1660	014	0	1	01	01	H1660_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1660	014	0	1	01	01	H1660_014_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1660	014	0	1	01	01	H1660_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1660	015	0	1	01	01	H1660_015_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H1660	015	0	1	01	01	H1660_015_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H1660	015	0	1	01	01	H1660_015_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1660	015	0	1	01	01	H1660_015_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1660	015	0	1	01	01	H1660_015_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1660	016	1	1	01	01	H1660_016_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H1660	016	1	1	01	01	H1660_016_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H1660	016	1	1	01	01	H1660_016_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1660	016	1	1	01	01	H1660_016_1	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1660	016	1	1	01	01	H1660_016_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1660	016	2	1	01	01	H1660_016_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H1660	016	2	1	01	01	H1660_016_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H1660	016	2	1	01	01	H1660_016_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1660	016	2	1	01	01	H1660_016_2	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1660	016	2	1	01	01	H1660_016_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1660	017	1	1	01	01	H1660_017_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H1660	017	1	1	01	01	H1660_017_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H1660	017	1	1	01	01	H1660_017_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1660	017	1	1	01	01	H1660_017_1	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1660	017	1	1	01	01	H1660_017_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1660	017	2	1	01	01	H1660_017_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H1660	017	2	1	01	01	H1660_017_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H1660	017	2	1	01	01	H1660_017_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1660	017	2	1	01	01	H1660_017_2	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1660	017	2	1	01	01	H1660_017_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1660	018	0	1	02	01	H1660_018_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H1660	018	0	1	02	01	H1660_018_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H1660	018	0	1	02	01	H1660_018_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1660	018	0	1	02	01	H1660_018_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1660	018	0	1	02	01	H1660_018_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1664	001	0	1	01	01	H1664_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1664	001	0	1	01	01	H1664_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1664	001	0	1	01	01	H1664_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1664	001	0	1	01	01	H1664_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1664	001	0	1	01	01	H1664_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1664	001	0	1	01	01	H1664_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1664	002	0	1	01	01	H1664_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1664	002	0	1	01	01	H1664_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1664	002	0	1	01	01	H1664_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1664	002	0	1	01	01	H1664_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1664	002	0	1	01	01	H1664_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1664	002	0	1	01	01	H1664_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1664	004	0	1	01	01	H1664_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1664	004	0	1	01	01	H1664_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1664	004	0	1	01	01	H1664_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1664	004	0	1	01	01	H1664_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1664	004	0	1	01	01	H1664_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1664	004	0	1	01	01	H1664_004_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1664	005	0	1	01	01	H1664_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1664	005	0	1	01	01	H1664_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1664	005	0	1	01	01	H1664_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1664	005	0	1	01	01	H1664_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1664	005	0	1	01	01	H1664_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1664	006	0	1	01	01	H1664_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1664	006	0	1	01	01	H1664_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1664	006	0	1	01	01	H1664_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1664	006	0	1	01	01	H1664_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1664	006	0	1	01	01	H1664_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1664	006	0	1	01	01	H1664_006_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1664	007	0	1	01	01	H1664_007_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1664	007	0	1	01	01	H1664_007_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1664	007	0	1	01	01	H1664_007_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1664	007	0	1	01	01	H1664_007_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1664	007	0	1	01	01	H1664_007_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1664	008	0	1	01	01	H1664_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1664	008	0	1	01	01	H1664_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1664	008	0	1	01	01	H1664_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1664	008	0	1	01	01	H1664_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1664	008	0	1	01	01	H1664_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1664	008	0	1	01	01	H1664_008_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1664	009	0	1	01	01	H1664_009_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1664	009	0	1	01	01	H1664_009_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1664	009	0	1	01	01	H1664_009_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1664	009	0	1	01	01	H1664_009_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1664	009	0	1	01	01	H1664_009_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1664	010	0	1	01	01	H1664_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1664	010	0	1	01	01	H1664_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1664	010	0	1	01	01	H1664_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1664	010	0	1	01	01	H1664_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1664	010	0	1	01	01	H1664_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1664	010	0	1	01	01	H1664_010_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1664	011	0	1	01	01	H1664_011_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1664	011	0	1	01	01	H1664_011_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1664	011	0	1	01	01	H1664_011_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1664	011	0	1	01	01	H1664_011_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1664	011	0	1	01	01	H1664_011_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1666	001	0	1	04	01	H1666_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1666	001	0	1	04	01	H1666_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1666	001	0	1	04	01	H1666_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1666	001	0	1	04	01	H1666_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1666	001	0	1	04	01	H1666_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1666	002	0	1	04	01	H1666_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1666	002	0	1	04	01	H1666_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1666	002	0	1	04	01	H1666_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1666	002	0	1	04	01	H1666_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1666	002	0	1	04	01	H1666_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1666	003	0	1	04	01	H1666_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1666	003	0	1	04	01	H1666_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1666	003	0	1	04	01	H1666_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1666	003	0	1	04	01	H1666_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1666	003	0	1	04	01	H1666_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1666	004	0	1	04	01	H1666_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1666	004	0	1	04	01	H1666_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1666	004	0	1	04	01	H1666_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1666	004	0	1	04	01	H1666_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1666	004	0	1	04	01	H1666_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1666	005	0	1	04	01	H1666_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1666	005	0	1	04	01	H1666_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1666	005	0	1	04	01	H1666_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1666	005	0	1	04	01	H1666_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1666	005	0	1	04	01	H1666_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1666	006	0	1	04	01	H1666_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1666	006	0	1	04	01	H1666_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1666	006	0	1	04	01	H1666_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1666	006	0	1	04	01	H1666_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1666	006	0	1	04	01	H1666_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1666	008	0	1	04	01	H1666_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1666	008	0	1	04	01	H1666_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1666	008	0	1	04	01	H1666_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1666	008	0	1	04	01	H1666_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1666	008	0	1	04	01	H1666_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1666	010	0	1	04	01	H1666_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1666	010	0	1	04	01	H1666_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1666	010	0	1	04	01	H1666_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1666	010	0	1	04	01	H1666_010_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1666	010	0	1	04	01	H1666_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1692	002	0	1	01	01	H1692_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1692	002	0	1	01	01	H1692_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1692	002	0	1	01	01	H1692_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1692	002	0	1	01	01	H1692_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1692	002	0	1	01	01	H1692_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1692	003	0	1	01	01	H1692_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1692	003	0	1	01	01	H1692_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1692	003	0	1	01	01	H1692_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1692	003	0	1	01	01	H1692_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1692	003	0	1	01	01	H1692_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1692	004	0	1	01	01	H1692_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1692	004	0	1	01	01	H1692_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1692	004	0	1	01	01	H1692_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1692	004	0	1	01	01	H1692_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1692	004	0	1	01	01	H1692_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1692	005	0	1	01	01	H1692_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1692	005	0	1	01	01	H1692_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1692	005	0	1	01	01	H1692_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1692	005	0	1	01	01	H1692_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1692	005	0	1	01	01	H1692_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1722	002	0	1	01	01	H1722_002_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1722	002	0	1	01	01	H1722_002_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1722	002	0	1	01	01	H1722_002_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1722	002	0	1	01	01	H1722_002_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1722	002	0	1	01	01	H1722_002_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1723	001	0	1	48	05	H1723_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H1723	001	0	1	48	05	H1723_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H1723	001	0	1	48	05	H1723_001_0	3	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H1732	001	0	1	01	01	H1732_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1732	001	0	1	01	01	H1732_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1732	001	0	1	01	01	H1732_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1732	001	0	1	01	01	H1732_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1732	001	0	1	01	01	H1732_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1732	001	0	1	01	01	H1732_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1732	002	0	1	01	01	H1732_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1732	002	0	1	01	01	H1732_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1732	002	0	1	01	01	H1732_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1732	002	0	1	01	01	H1732_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1732	002	0	1	01	01	H1732_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1732	002	0	1	01	01	H1732_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1732	003	0	1	01	01	H1732_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H1732	003	0	1	01	01	H1732_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1732	003	0	1	01	01	H1732_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1732	003	0	1	01	01	H1732_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1732	003	0	1	01	01	H1732_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1732	003	0	1	01	01	H1732_003_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1732	004	0	1	01	01	H1732_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H1732	004	0	1	01	01	H1732_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1732	004	0	1	01	01	H1732_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1732	004	0	1	01	01	H1732_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1732	004	0	1	01	01	H1732_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1732	004	0	1	01	01	H1732_004_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1732	005	0	1	01	01	H1732_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1732	005	0	1	01	01	H1732_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1732	005	0	1	01	01	H1732_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1732	005	0	1	01	01	H1732_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1732	005	0	1	01	01	H1732_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1732	005	0	1	01	01	H1732_005_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1732	006	0	1	01	01	H1732_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H1732	006	0	1	01	01	H1732_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1732	006	0	1	01	01	H1732_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1732	006	0	1	01	01	H1732_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1732	006	0	1	01	01	H1732_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1732	006	0	1	01	01	H1732_006_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1737	001	0	1	01	01	H1737_001_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1737	001	0	1	01	01	H1737_001_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1737	001	0	1	01	01	H1737_001_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1737	001	0	1	01	01	H1737_001_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1737	001	0	1	01	01	H1737_001_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1748	001	0	1	01	01	H1748_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1748	001	0	1	01	01	H1748_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1748	001	0	1	01	01	H1748_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1748	001	0	1	01	01	H1748_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1748	001	0	1	01	01	H1748_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1748	002	0	1	01	01	H1748_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1748	002	0	1	01	01	H1748_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1748	002	0	1	01	01	H1748_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H1748	002	0	1	01	01	H1748_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1748	002	0	1	01	01	H1748_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1748	003	0	1	01	01	H1748_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1748	003	0	1	01	01	H1748_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H1748	003	0	1	01	01	H1748_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H1748	003	0	1	01	01	H1748_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1748	003	0	1	01	01	H1748_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1748	003	0	1	01	01	H1748_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1748	004	0	1	01	01	H1748_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1748	004	0	1	01	01	H1748_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H1748	004	0	1	01	01	H1748_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H1748	004	0	1	01	01	H1748_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1748	004	0	1	01	01	H1748_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1748	004	0	1	01	01	H1748_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1774	001	0	1	04	01	H1774_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1774	001	0	1	04	01	H1774_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1774	001	0	1	04	01	H1774_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1774	001	0	1	04	01	H1774_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1774	001	0	1	04	01	H1774_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1774	001	0	1	04	01	H1774_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1787	002	0	1	01	01	H1787_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H1787	002	0	1	01	01	H1787_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H1787	002	0	1	01	01	H1787_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H1787	002	0	1	01	01	H1787_002_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H1787	002	0	1	01	01	H1787_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1821	001	0	1	04	01	H1821_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1821	001	0	1	04	01	H1821_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1821	001	0	1	04	01	H1821_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1821	001	0	1	04	01	H1821_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1821	001	0	1	04	01	H1821_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1821	002	0	1	04	01	H1821_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1821	002	0	1	04	01	H1821_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1821	002	0	1	04	01	H1821_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1821	002	0	1	04	01	H1821_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1821	002	0	1	04	01	H1821_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1821	003	0	1	04	01	H1821_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1821	003	0	1	04	01	H1821_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1821	003	0	1	04	01	H1821_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1821	003	0	1	04	01	H1821_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1821	003	0	1	04	01	H1821_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1846	004	0	1	04	01	H1846_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1846	004	0	1	04	01	H1846_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1846	004	0	1	04	01	H1846_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1846	004	0	1	04	01	H1846_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1846	004	0	1	04	01	H1846_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1848	001	0	1	04	01	H1848_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1848	001	0	1	04	01	H1848_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1848	001	0	1	04	01	H1848_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1848	001	0	1	04	01	H1848_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1848	001	0	1	04	01	H1848_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1848	002	0	1	04	01	H1848_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1848	002	0	1	04	01	H1848_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1848	002	0	1	04	01	H1848_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1848	002	0	1	04	01	H1848_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1848	002	0	1	04	01	H1848_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1862	001	0	1	01	01	H1862_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1862	001	0	1	01	01	H1862_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1862	001	0	1	01	01	H1862_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1862	001	0	1	01	01	H1862_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1862	001	0	1	01	01	H1862_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1894	001	0	1	01	01	H1894_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H1894	001	0	1	01	01	H1894_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1894	001	0	1	01	01	H1894_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1894	001	0	1	01	01	H1894_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1894	001	0	1	01	01	H1894_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1894	001	0	1	01	01	H1894_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1894	002	0	1	01	01	H1894_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1894	002	0	1	01	01	H1894_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1894	002	0	1	01	01	H1894_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1894	002	0	1	01	01	H1894_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1894	002	0	1	01	01	H1894_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1894	002	0	1	01	01	H1894_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1914	001	0	1	04	01	H1914_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1914	001	0	1	04	01	H1914_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1914	001	0	1	04	01	H1914_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1914	001	0	1	04	01	H1914_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1914	001	0	1	04	01	H1914_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1914	002	0	1	04	01	H1914_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1914	002	0	1	04	01	H1914_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1914	002	0	1	04	01	H1914_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1914	002	0	1	04	01	H1914_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1914	002	0	1	04	01	H1914_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1914	003	0	1	04	01	H1914_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H1914	003	0	1	04	01	H1914_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1914	003	0	1	04	01	H1914_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1914	003	0	1	04	01	H1914_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1914	003	0	1	04	01	H1914_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	001	0	1	01	01	H1944_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	001	0	1	01	01	H1944_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	001	0	1	01	01	H1944_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	001	0	1	01	01	H1944_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	001	0	1	01	01	H1944_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	004	0	1	01	01	H1944_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	004	0	1	01	01	H1944_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	004	0	1	01	01	H1944_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	004	0	1	01	01	H1944_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	004	0	1	01	01	H1944_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	005	0	1	01	01	H1944_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	005	0	1	01	01	H1944_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	005	0	1	01	01	H1944_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	005	0	1	01	01	H1944_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	005	0	1	01	01	H1944_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	006	0	1	01	01	H1944_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	006	0	1	01	01	H1944_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	006	0	1	01	01	H1944_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	006	0	1	01	01	H1944_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	006	0	1	01	01	H1944_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	009	0	1	01	01	H1944_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	009	0	1	01	01	H1944_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	009	0	1	01	01	H1944_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	009	0	1	01	01	H1944_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	009	0	1	01	01	H1944_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	010	0	1	01	01	H1944_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	010	0	1	01	01	H1944_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	010	0	1	01	01	H1944_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	010	0	1	01	01	H1944_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	010	0	1	01	01	H1944_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	011	0	1	01	01	H1944_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	011	0	1	01	01	H1944_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	011	0	1	01	01	H1944_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	011	0	1	01	01	H1944_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	011	0	1	01	01	H1944_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	014	0	1	02	01	H1944_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	014	0	1	02	01	H1944_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	014	0	1	02	01	H1944_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	014	0	1	02	01	H1944_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	014	0	1	02	01	H1944_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	016	0	1	02	01	H1944_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	016	0	1	02	01	H1944_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	016	0	1	02	01	H1944_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	016	0	1	02	01	H1944_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	016	0	1	02	01	H1944_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	017	0	1	01	01	H1944_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	017	0	1	01	01	H1944_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	017	0	1	01	01	H1944_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	017	0	1	01	01	H1944_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	017	0	1	01	01	H1944_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	018	0	1	01	01	H1944_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	018	0	1	01	01	H1944_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	018	0	1	01	01	H1944_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	018	0	1	01	01	H1944_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	018	0	1	01	01	H1944_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	024	0	1	01	01	H1944_024_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	024	0	1	01	01	H1944_024_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	024	0	1	01	01	H1944_024_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	024	0	1	01	01	H1944_024_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	024	0	1	01	01	H1944_024_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	028	0	1	01	01	H1944_028_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	028	0	1	01	01	H1944_028_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	028	0	1	01	01	H1944_028_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	028	0	1	01	01	H1944_028_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	028	0	1	01	01	H1944_028_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	031	0	1	01	01	H1944_031_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	031	0	1	01	01	H1944_031_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	031	0	1	01	01	H1944_031_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	031	0	1	01	01	H1944_031_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	031	0	1	01	01	H1944_031_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1944	032	0	1	01	01	H1944_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1944	032	0	1	01	01	H1944_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1944	032	0	1	01	01	H1944_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1944	032	0	1	01	01	H1944_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1944	032	0	1	01	01	H1944_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1947	001	0	1	01	01	H1947_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H1947	001	0	1	01	01	H1947_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H1947	001	0	1	01	01	H1947_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1947	001	0	1	01	01	H1947_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1947	001	0	1	01	01	H1947_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1947	001	0	1	01	01	H1947_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H1951	013	0	1	01	01	H1951_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	013	0	1	01	01	H1951_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	013	0	1	01	01	H1951_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	013	0	1	01	01	H1951_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	013	0	1	01	01	H1951_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	024	0	1	01	01	H1951_024_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	024	0	1	01	01	H1951_024_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	024	0	1	01	01	H1951_024_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	024	0	1	01	01	H1951_024_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	024	0	1	01	01	H1951_024_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	028	0	1	01	01	H1951_028_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	028	0	1	01	01	H1951_028_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	028	0	1	01	01	H1951_028_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	028	0	1	01	01	H1951_028_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	028	0	1	01	01	H1951_028_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	032	0	1	01	01	H1951_032_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	032	0	1	01	01	H1951_032_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	032	0	1	01	01	H1951_032_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	032	0	1	01	01	H1951_032_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	032	0	1	01	01	H1951_032_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	033	0	1	01	01	H1951_033_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	033	0	1	01	01	H1951_033_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	033	0	1	01	01	H1951_033_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	033	0	1	01	01	H1951_033_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	033	0	1	01	01	H1951_033_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	034	0	1	01	01	H1951_034_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	034	0	1	01	01	H1951_034_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	034	0	1	01	01	H1951_034_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	034	0	1	01	01	H1951_034_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	034	0	1	01	01	H1951_034_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	038	0	1	01	01	H1951_038_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	038	0	1	01	01	H1951_038_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	038	0	1	01	01	H1951_038_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	038	0	1	01	01	H1951_038_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	038	0	1	01	01	H1951_038_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	039	0	1	01	01	H1951_039_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	039	0	1	01	01	H1951_039_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	039	0	1	01	01	H1951_039_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	039	0	1	01	01	H1951_039_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	039	0	1	01	01	H1951_039_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	041	0	1	01	01	H1951_041_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	041	0	1	01	01	H1951_041_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	041	0	1	01	01	H1951_041_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	041	0	1	01	01	H1951_041_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	041	0	1	01	01	H1951_041_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	044	0	1	01	01	H1951_044_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H1951	044	0	1	01	01	H1951_044_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H1951	044	0	1	01	01	H1951_044_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H1951	044	0	1	01	01	H1951_044_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H1951	044	0	1	01	01	H1951_044_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H1951	044	0	1	01	01	H1951_044_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H1951	047	1	1	01	01	H1951_047_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	047	1	1	01	01	H1951_047_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	047	1	1	01	01	H1951_047_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	047	1	1	01	01	H1951_047_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	047	1	1	01	01	H1951_047_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	047	2	1	01	01	H1951_047_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	047	2	1	01	01	H1951_047_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	047	2	1	01	01	H1951_047_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	047	2	1	01	01	H1951_047_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	047	2	1	01	01	H1951_047_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	048	1	1	01	01	H1951_048_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	048	1	1	01	01	H1951_048_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	048	1	1	01	01	H1951_048_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	048	1	1	01	01	H1951_048_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	048	1	1	01	01	H1951_048_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	048	2	1	01	01	H1951_048_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	048	2	1	01	01	H1951_048_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	048	2	1	01	01	H1951_048_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	048	2	1	01	01	H1951_048_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	048	2	1	01	01	H1951_048_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	049	1	1	01	01	H1951_049_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	049	1	1	01	01	H1951_049_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	049	1	1	01	01	H1951_049_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	049	1	1	01	01	H1951_049_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	049	1	1	01	01	H1951_049_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	049	2	1	01	01	H1951_049_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	049	2	1	01	01	H1951_049_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	049	2	1	01	01	H1951_049_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	049	2	1	01	01	H1951_049_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	049	2	1	01	01	H1951_049_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	049	3	1	01	01	H1951_049_3	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	049	3	1	01	01	H1951_049_3	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	049	3	1	01	01	H1951_049_3	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	049	3	1	01	01	H1951_049_3	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	049	3	1	01	01	H1951_049_3	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	051	0	1	01	01	H1951_051_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	051	0	1	01	01	H1951_051_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	051	0	1	01	01	H1951_051_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	051	0	1	01	01	H1951_051_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	051	0	1	01	01	H1951_051_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1951	052	0	1	01	01	H1951_052_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H1951	052	0	1	01	01	H1951_052_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H1951	052	0	1	01	01	H1951_052_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1951	052	0	1	01	01	H1951_052_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1951	052	0	1	01	01	H1951_052_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1961	014	1	1	01	01	H1961_014_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1961	014	1	1	01	01	H1961_014_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1961	014	1	1	01	01	H1961_014_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1961	014	1	1	01	01	H1961_014_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1961	014	1	1	01	01	H1961_014_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1961	014	2	1	01	01	H1961_014_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1961	014	2	1	01	01	H1961_014_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1961	014	2	1	01	01	H1961_014_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1961	014	2	1	01	01	H1961_014_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1961	014	2	1	01	01	H1961_014_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1961	014	3	1	01	01	H1961_014_3	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1961	014	3	1	01	01	H1961_014_3	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1961	014	3	1	01	01	H1961_014_3	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1961	014	3	1	01	01	H1961_014_3	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1961	014	3	1	01	01	H1961_014_3	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1961	014	4	1	01	01	H1961_014_4	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1961	014	4	1	01	01	H1961_014_4	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1961	014	4	1	01	01	H1961_014_4	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1961	014	4	1	01	01	H1961_014_4	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1961	014	4	1	01	01	H1961_014_4	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1961	017	0	1	01	01	H1961_017_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1961	017	0	1	01	01	H1961_017_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1961	017	0	1	01	01	H1961_017_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1961	017	0	1	01	01	H1961_017_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1961	017	0	1	01	01	H1961_017_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1961	018	0	1	01	01	H1961_018_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1961	018	0	1	01	01	H1961_018_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1961	018	0	1	01	01	H1961_018_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1961	018	0	1	01	01	H1961_018_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1961	018	0	1	01	01	H1961_018_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1969	002	0	1	01	01	H1969_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1969	002	0	1	01	01	H1969_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1969	002	0	1	01	01	H1969_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1969	002	0	1	01	01	H1969_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1969	002	0	1	01	01	H1969_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1969	004	0	1	01	01	H1969_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1969	004	0	1	01	01	H1969_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1969	004	0	1	01	01	H1969_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1969	004	0	1	01	01	H1969_004_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1969	004	0	1	01	01	H1969_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1969	007	3	1	01	01	H1969_007_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1969	007	3	1	01	01	H1969_007_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1969	007	3	1	01	01	H1969_007_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1969	007	3	1	01	01	H1969_007_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1969	007	3	1	01	01	H1969_007_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1969	007	4	1	01	01	H1969_007_4	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1969	007	4	1	01	01	H1969_007_4	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1969	007	4	1	01	01	H1969_007_4	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1969	007	4	1	01	01	H1969_007_4	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1969	007	4	1	01	01	H1969_007_4	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1969	008	1	1	01	01	H1969_008_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1969	008	1	1	01	01	H1969_008_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1969	008	1	1	01	01	H1969_008_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1969	008	1	1	01	01	H1969_008_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1969	008	1	1	01	01	H1969_008_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1969	008	2	1	01	01	H1969_008_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1969	008	2	1	01	01	H1969_008_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1969	008	2	1	01	01	H1969_008_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1969	008	2	1	01	01	H1969_008_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1969	008	2	1	01	01	H1969_008_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1977	001	0	1	48	05	H1977_001_0	2	Generic Drugs	4	Generic Drugs, Brand Drugs	1	2	01					3	0.00	0.00
H1977	001	0	1	48	05	H1977_001_0	2	Brand Drugs	4	Generic Drugs, Brand Drugs	2	2	10					3	0.00	0.00
H1993	001	0	1	01	01	H1993_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1993	001	0	1	01	01	H1993_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1993	001	0	1	01	01	H1993_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1993	001	0	1	01	01	H1993_001_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1993	001	0	1	01	01	H1993_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1993	002	0	1	01	01	H1993_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1993	002	0	1	01	01	H1993_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1993	002	0	1	01	01	H1993_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1993	002	0	1	01	01	H1993_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1993	002	0	1	01	01	H1993_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1993	003	0	1	01	01	H1993_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1993	003	0	1	01	01	H1993_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1993	003	0	1	01	01	H1993_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1993	003	0	1	01	01	H1993_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1993	003	0	1	01	01	H1993_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1993	004	0	1	01	01	H1993_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1993	004	0	1	01	01	H1993_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H1993	004	0	1	01	01	H1993_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1993	004	0	1	01	01	H1993_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1993	004	0	1	01	01	H1993_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1994	001	0	1	01	01	H1994_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H1994	001	0	1	01	01	H1994_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H1994	001	0	1	01	01	H1994_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1994	001	0	1	01	01	H1994_001_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1994	001	0	1	01	01	H1994_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1994	002	0	1	01	01	H1994_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H1994	002	0	1	01	01	H1994_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H1994	002	0	1	01	01	H1994_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1994	002	0	1	01	01	H1994_002_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1994	002	0	1	01	01	H1994_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1994	003	0	1	01	01	H1994_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H1994	003	0	1	01	01	H1994_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H1994	003	0	1	01	01	H1994_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1994	003	0	1	01	01	H1994_003_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1994	003	0	1	01	01	H1994_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1994	004	0	1	01	01	H1994_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H1994	004	0	1	01	01	H1994_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H1994	004	0	1	01	01	H1994_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1994	004	0	1	01	01	H1994_004_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1994	004	0	1	01	01	H1994_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1994	007	0	1	01	01	H1994_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H1994	007	0	1	01	01	H1994_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H1994	007	0	1	01	01	H1994_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1994	007	0	1	01	01	H1994_007_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1994	007	0	1	01	01	H1994_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1994	008	0	1	01	01	H1994_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H1994	008	0	1	01	01	H1994_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H1994	008	0	1	01	01	H1994_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1994	008	0	1	01	01	H1994_008_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1994	008	0	1	01	01	H1994_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1994	012	0	1	01	01	H1994_012_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H1994	012	0	1	01	01	H1994_012_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H1994	012	0	1	01	01	H1994_012_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1994	012	0	1	01	01	H1994_012_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1994	012	0	1	01	01	H1994_012_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1994	013	0	1	01	01	H1994_013_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H1994	013	0	1	01	01	H1994_013_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H1994	013	0	1	01	01	H1994_013_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1994	013	0	1	01	01	H1994_013_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1994	013	0	1	01	01	H1994_013_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1994	014	0	1	01	01	H1994_014_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H1994	014	0	1	01	01	H1994_014_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H1994	014	0	1	01	01	H1994_014_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H1994	014	0	1	01	01	H1994_014_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H1994	014	0	1	01	01	H1994_014_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H1997	002	0	1	01	01	H1997_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1997	002	0	1	01	01	H1997_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1997	002	0	1	01	01	H1997_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1997	002	0	1	01	01	H1997_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1997	002	0	1	01	01	H1997_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1997	009	0	1	01	01	H1997_009_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1997	009	0	1	01	01	H1997_009_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1997	009	0	1	01	01	H1997_009_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1997	009	0	1	01	01	H1997_009_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1997	009	0	1	01	01	H1997_009_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1997	010	0	1	01	01	H1997_010_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1997	010	0	1	01	01	H1997_010_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1997	010	0	1	01	01	H1997_010_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1997	010	0	1	01	01	H1997_010_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1997	010	0	1	01	01	H1997_010_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H1997	011	0	1	01	01	H1997_011_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H1997	011	0	1	01	01	H1997_011_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H1997	011	0	1	01	01	H1997_011_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H1997	011	0	1	01	01	H1997_011_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H1997	011	0	1	01	01	H1997_011_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2001	001	0	1	04	01	H2001_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2001	001	0	1	04	01	H2001_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2001	001	0	1	04	01	H2001_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2001	001	0	1	04	01	H2001_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2001	001	0	1	04	01	H2001_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2001	010	0	1	04	01	H2001_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2001	010	0	1	04	01	H2001_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2001	010	0	1	04	01	H2001_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2001	010	0	1	04	01	H2001_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2001	010	0	1	04	01	H2001_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2001	017	0	1	04	01	H2001_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2001	017	0	1	04	01	H2001_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2001	017	0	1	04	01	H2001_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2001	017	0	1	04	01	H2001_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2001	017	0	1	04	01	H2001_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2001	018	0	1	04	01	H2001_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2001	018	0	1	04	01	H2001_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2001	018	0	1	04	01	H2001_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2001	018	0	1	04	01	H2001_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2001	018	0	1	04	01	H2001_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2001	019	0	1	04	01	H2001_019_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2001	019	0	1	04	01	H2001_019_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2001	019	0	1	04	01	H2001_019_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2001	019	0	1	04	01	H2001_019_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2001	019	0	1	04	01	H2001_019_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2011	001	0	1	01	01	H2011_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2011	001	0	1	01	01	H2011_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2011	001	0	1	01	01	H2011_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2011	001	0	1	01	01	H2011_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2011	001	0	1	01	01	H2011_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2011	001	0	1	01	01	H2011_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H2011	002	0	1	01	01	H2011_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2011	002	0	1	01	01	H2011_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2011	002	0	1	01	01	H2011_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2011	002	0	1	01	01	H2011_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2011	002	0	1	01	01	H2011_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2011	002	0	1	01	01	H2011_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H2011	003	0	1	01	01	H2011_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2011	003	0	1	01	01	H2011_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2011	003	0	1	01	01	H2011_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2011	003	0	1	01	01	H2011_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2011	003	0	1	01	01	H2011_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2011	003	0	1	01	01	H2011_003_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H2011	004	0	1	01	01	H2011_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2011	004	0	1	01	01	H2011_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2011	004	0	1	01	01	H2011_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2011	004	0	1	01	01	H2011_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2011	004	0	1	01	01	H2011_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2011	004	0	1	01	01	H2011_004_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H2020	001	0	1	04	01	H2020_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2020	001	0	1	04	01	H2020_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2020	001	0	1	04	01	H2020_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2020	001	0	1	04	01	H2020_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H2020	001	0	1	04	01	H2020_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2020	002	0	1	04	01	H2020_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2020	002	0	1	04	01	H2020_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2020	002	0	1	04	01	H2020_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2020	002	0	1	04	01	H2020_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H2020	002	0	1	04	01	H2020_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2020	003	0	1	04	01	H2020_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2020	003	0	1	04	01	H2020_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2020	003	0	1	04	01	H2020_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2020	003	0	1	04	01	H2020_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H2020	003	0	1	04	01	H2020_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2020	004	0	1	04	01	H2020_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2020	004	0	1	04	01	H2020_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2020	004	0	1	04	01	H2020_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2020	004	0	1	04	01	H2020_004_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H2020	004	0	1	04	01	H2020_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2020	005	0	1	04	01	H2020_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2020	005	0	1	04	01	H2020_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2020	005	0	1	04	01	H2020_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2020	005	0	1	04	01	H2020_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H2020	005	0	1	04	01	H2020_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2029	001	0	1	04	01	H2029_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H2029	001	0	1	04	01	H2029_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2029	001	0	1	04	01	H2029_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2029	001	0	1	04	01	H2029_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2029	001	0	1	04	01	H2029_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2029	001	0	1	04	01	H2029_001_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2032	001	0	1	04	01	H2032_001_0	15	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2032	001	0	1	04	01	H2032_001_0	15	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2032	001	0	1	04	01	H2032_001_0	15	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2032	001	0	1	04	01	H2032_001_0	15	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2032	001	0	1	04	01	H2032_001_0	15	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2032	002	0	1	04	01	H2032_002_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2032	002	0	1	04	01	H2032_002_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2032	002	0	1	04	01	H2032_002_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2032	002	0	1	04	01	H2032_002_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2032	002	0	1	04	01	H2032_002_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2032	003	0	1	04	01	H2032_003_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2032	003	0	1	04	01	H2032_003_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2032	003	0	1	04	01	H2032_003_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2032	003	0	1	04	01	H2032_003_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2032	003	0	1	04	01	H2032_003_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2056	001	0	1	01	01	H2056_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2056	001	0	1	01	01	H2056_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2056	001	0	1	01	01	H2056_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2056	001	0	1	01	01	H2056_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2056	001	0	1	01	01	H2056_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2056	002	0	1	01	01	H2056_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2056	002	0	1	01	01	H2056_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2056	002	0	1	01	01	H2056_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2056	002	0	1	01	01	H2056_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2056	002	0	1	01	01	H2056_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2056	003	0	1	01	01	H2056_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2056	003	0	1	01	01	H2056_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2056	003	0	1	01	01	H2056_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2056	003	0	1	01	01	H2056_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2056	003	0	1	01	01	H2056_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2056	004	0	1	01	01	H2056_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2056	004	0	1	01	01	H2056_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2056	004	0	1	01	01	H2056_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2056	004	0	1	01	01	H2056_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2056	004	0	1	01	01	H2056_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2056	005	0	1	01	01	H2056_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2056	005	0	1	01	01	H2056_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2056	005	0	1	01	01	H2056_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2056	005	0	1	01	01	H2056_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2056	005	0	1	01	01	H2056_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2056	007	0	1	01	01	H2056_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2056	007	0	1	01	01	H2056_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2056	007	0	1	01	01	H2056_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2056	007	0	1	01	01	H2056_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2056	007	0	1	01	01	H2056_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2108	022	0	1	01	01	H2108_022_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2108	022	0	1	01	01	H2108_022_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2108	022	0	1	01	01	H2108_022_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2108	022	0	1	01	01	H2108_022_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2108	022	0	1	01	01	H2108_022_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2108	028	0	1	01	01	H2108_028_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2108	028	0	1	01	01	H2108_028_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2108	028	0	1	01	01	H2108_028_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2108	028	0	1	01	01	H2108_028_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2108	028	0	1	01	01	H2108_028_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2108	029	0	1	01	01	H2108_029_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H2108	029	0	1	01	01	H2108_029_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	01	1						
H2108	029	0	1	01	01	H2108_029_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	1						
H2108	029	0	1	01	01	H2108_029_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H2108	029	0	1	01	01	H2108_029_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H2108	029	0	1	01	01	H2108_029_0	6	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H2108	030	0	1	01	01	H2108_030_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H2108	030	0	1	01	01	H2108_030_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	01	1						
H2108	030	0	1	01	01	H2108_030_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	1						
H2108	030	0	1	01	01	H2108_030_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H2108	030	0	1	01	01	H2108_030_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H2108	030	0	1	01	01	H2108_030_0	6	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H2108	034	0	1	01	01	H2108_034_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2108	034	0	1	01	01	H2108_034_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2108	034	0	1	01	01	H2108_034_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2108	034	0	1	01	01	H2108_034_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2108	034	0	1	01	01	H2108_034_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2108	036	0	1	01	01	H2108_036_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2108	036	0	1	01	01	H2108_036_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2108	036	0	1	01	01	H2108_036_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2108	036	0	1	01	01	H2108_036_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2108	036	0	1	01	01	H2108_036_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2120	001	0	1	01	01	H2120_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2120	001	0	1	01	01	H2120_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2120	001	0	1	01	01	H2120_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2120	001	0	1	01	01	H2120_001_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2120	001	0	1	01	01	H2120_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2120	001	0	1	01	01	H2120_001_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2120	002	0	1	01	01	H2120_002_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2120	002	0	1	01	01	H2120_002_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2120	002	0	1	01	01	H2120_002_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2120	002	0	1	01	01	H2120_002_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2120	002	0	1	01	01	H2120_002_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2120	002	0	1	01	01	H2120_002_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2120	003	0	1	01	01	H2120_003_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2120	003	0	1	01	01	H2120_003_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2120	003	0	1	01	01	H2120_003_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2120	003	0	1	01	01	H2120_003_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2120	003	0	1	01	01	H2120_003_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2120	003	0	1	01	01	H2120_003_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2120	004	0	1	01	01	H2120_004_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2120	004	0	1	01	01	H2120_004_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2120	004	0	1	01	01	H2120_004_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2120	004	0	1	01	01	H2120_004_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2120	004	0	1	01	01	H2120_004_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2120	004	0	1	01	01	H2120_004_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2134	001	0	1	01	01	H2134_001_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2134	001	0	1	01	01	H2134_001_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2134	001	0	1	01	01	H2134_001_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2134	001	0	1	01	01	H2134_001_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2134	001	0	1	01	01	H2134_001_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2134	002	0	1	01	01	H2134_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2134	002	0	1	01	01	H2134_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2134	002	0	1	01	01	H2134_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2134	002	0	1	01	01	H2134_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2134	002	0	1	01	01	H2134_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2134	002	0	1	01	01	H2134_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2134	003	0	1	01	01	H2134_003_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2134	003	0	1	01	01	H2134_003_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2134	003	0	1	01	01	H2134_003_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2134	003	0	1	01	01	H2134_003_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2134	003	0	1	01	01	H2134_003_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2134	004	0	1	01	01	H2134_004_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2134	004	0	1	01	01	H2134_004_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2134	004	0	1	01	01	H2134_004_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2134	004	0	1	01	01	H2134_004_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2134	004	0	1	01	01	H2134_004_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2134	005	0	1	01	01	H2134_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2134	005	0	1	01	01	H2134_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2134	005	0	1	01	01	H2134_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2134	005	0	1	01	01	H2134_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2134	005	0	1	01	01	H2134_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2134	005	0	1	01	01	H2134_005_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2161	002	0	1	02	01	H2161_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2161	002	0	1	02	01	H2161_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2161	002	0	1	02	01	H2161_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2161	002	0	1	02	01	H2161_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2161	002	0	1	02	01	H2161_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2161	003	0	1	01	01	H2161_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2161	003	0	1	01	01	H2161_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2161	003	0	1	01	01	H2161_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2161	003	0	1	01	01	H2161_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2161	003	0	1	01	01	H2161_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2162	001	0	1	01	01	H2162_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2162	001	0	1	01	01	H2162_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2162	001	0	1	01	01	H2162_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2162	001	0	1	01	01	H2162_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2162	001	0	1	01	01	H2162_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2162	002	0	1	01	01	H2162_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2162	002	0	1	01	01	H2162_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2162	002	0	1	01	01	H2162_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2162	002	0	1	01	01	H2162_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2162	002	0	1	01	01	H2162_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2171	001	0	1	01	01	H2171_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2171	001	0	1	01	01	H2171_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2171	001	0	1	01	01	H2171_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2171	001	0	1	01	01	H2171_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2171	001	0	1	01	01	H2171_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2172	001	0	1	01	01	H2172_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	001	0	1	01	01	H2172_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	001	0	1	01	01	H2172_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	001	0	1	01	01	H2172_001_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	001	0	1	01	01	H2172_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	001	0	1	01	01	H2172_001_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2172	002	0	1	01	01	H2172_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	002	0	1	01	01	H2172_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	002	0	1	01	01	H2172_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	002	0	1	01	01	H2172_002_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	002	0	1	01	01	H2172_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	002	0	1	01	01	H2172_002_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2172	003	0	1	01	01	H2172_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	003	0	1	01	01	H2172_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	003	0	1	01	01	H2172_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	003	0	1	01	01	H2172_003_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	003	0	1	01	01	H2172_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	003	0	1	01	01	H2172_003_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2172	004	0	1	01	01	H2172_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	004	0	1	01	01	H2172_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	004	0	1	01	01	H2172_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	004	0	1	01	01	H2172_004_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	004	0	1	01	01	H2172_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	004	0	1	01	01	H2172_004_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2172	006	0	1	01	01	H2172_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	006	0	1	01	01	H2172_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	006	0	1	01	01	H2172_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	006	0	1	01	01	H2172_006_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	006	0	1	01	01	H2172_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	006	0	1	01	01	H2172_006_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2172	008	0	1	01	01	H2172_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	008	0	1	01	01	H2172_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	008	0	1	01	01	H2172_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	008	0	1	01	01	H2172_008_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	008	0	1	01	01	H2172_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	008	0	1	01	01	H2172_008_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2172	009	0	1	01	01	H2172_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	009	0	1	01	01	H2172_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	009	0	1	01	01	H2172_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	009	0	1	01	01	H2172_009_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	009	0	1	01	01	H2172_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	009	0	1	01	01	H2172_009_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2172	010	0	1	01	01	H2172_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	010	0	1	01	01	H2172_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	010	0	1	01	01	H2172_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	010	0	1	01	01	H2172_010_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	010	0	1	01	01	H2172_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	010	0	1	01	01	H2172_010_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2172	011	0	1	01	01	H2172_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	011	0	1	01	01	H2172_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	011	0	1	01	01	H2172_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	011	0	1	01	01	H2172_011_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	011	0	1	01	01	H2172_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	011	0	1	01	01	H2172_011_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2172	012	0	1	01	01	H2172_012_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	1		5			
H2172	012	0	1	01	01	H2172_012_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	1		5			
H2172	012	0	1	01	01	H2172_012_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	1		5			
H2172	012	0	1	01	01	H2172_012_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	1		5			
H2172	012	0	1	01	01	H2172_012_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	1		5			
H2172	012	0	1	01	01	H2172_012_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H2174	001	0	1	01	01	H2174_001_0	6	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2174	001	0	1	01	01	H2174_001_0	6	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2174	001	0	1	01	01	H2174_001_0	6	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2174	001	0	1	01	01	H2174_001_0	6	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2174	001	0	1	01	01	H2174_001_0	6	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2196	001	0	1	01	01	H2196_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2196	001	0	1	01	01	H2196_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2196	001	0	1	01	01	H2196_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2196	001	0	1	01	01	H2196_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2196	001	0	1	01	01	H2196_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2196	002	0	1	01	01	H2196_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2196	002	0	1	01	01	H2196_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2196	002	0	1	01	01	H2196_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2196	002	0	1	01	01	H2196_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2196	002	0	1	01	01	H2196_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2225	001	0	1	01	01	H2225_001_0	9	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2225	001	0	1	01	01	H2225_001_0	9	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H2225	001	0	1	01	01	H2225_001_0	9	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2225	001	0	1	01	01	H2225_001_0	9	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H2225	001	0	1	01	01	H2225_001_0	9	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2228	011	0	1	04	01	H2228_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	011	0	1	04	01	H2228_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	011	0	1	04	01	H2228_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	011	0	1	04	01	H2228_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	011	0	1	04	01	H2228_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	017	0	1	04	01	H2228_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	017	0	1	04	01	H2228_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	017	0	1	04	01	H2228_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	017	0	1	04	01	H2228_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	017	0	1	04	01	H2228_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	018	0	1	04	01	H2228_018_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	018	0	1	04	01	H2228_018_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	018	0	1	04	01	H2228_018_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	018	0	1	04	01	H2228_018_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	018	0	1	04	01	H2228_018_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	019	0	1	04	01	H2228_019_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	019	0	1	04	01	H2228_019_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	019	0	1	04	01	H2228_019_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	019	0	1	04	01	H2228_019_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	019	0	1	04	01	H2228_019_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	020	0	1	04	01	H2228_020_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	020	0	1	04	01	H2228_020_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	020	0	1	04	01	H2228_020_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	020	0	1	04	01	H2228_020_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	020	0	1	04	01	H2228_020_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	021	0	1	04	01	H2228_021_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	021	0	1	04	01	H2228_021_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	021	0	1	04	01	H2228_021_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	021	0	1	04	01	H2228_021_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	021	0	1	04	01	H2228_021_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	022	0	1	04	01	H2228_022_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	022	0	1	04	01	H2228_022_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	022	0	1	04	01	H2228_022_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	022	0	1	04	01	H2228_022_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	022	0	1	04	01	H2228_022_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	023	0	1	04	01	H2228_023_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	023	0	1	04	01	H2228_023_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	023	0	1	04	01	H2228_023_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	023	0	1	04	01	H2228_023_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	023	0	1	04	01	H2228_023_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	024	0	1	04	01	H2228_024_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	024	0	1	04	01	H2228_024_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	024	0	1	04	01	H2228_024_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	024	0	1	04	01	H2228_024_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	024	0	1	04	01	H2228_024_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	029	0	1	04	01	H2228_029_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	029	0	1	04	01	H2228_029_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	029	0	1	04	01	H2228_029_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	029	0	1	04	01	H2228_029_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	029	0	1	04	01	H2228_029_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	030	0	1	04	01	H2228_030_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	030	0	1	04	01	H2228_030_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	030	0	1	04	01	H2228_030_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	030	0	1	04	01	H2228_030_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	030	0	1	04	01	H2228_030_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	031	0	1	04	01	H2228_031_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	031	0	1	04	01	H2228_031_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	031	0	1	04	01	H2228_031_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	031	0	1	04	01	H2228_031_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	031	0	1	04	01	H2228_031_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	032	0	1	04	01	H2228_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	032	0	1	04	01	H2228_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	032	0	1	04	01	H2228_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	032	0	1	04	01	H2228_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	032	0	1	04	01	H2228_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	035	0	1	04	01	H2228_035_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	035	0	1	04	01	H2228_035_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	035	0	1	04	01	H2228_035_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	035	0	1	04	01	H2228_035_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	035	0	1	04	01	H2228_035_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	036	0	1	04	01	H2228_036_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	036	0	1	04	01	H2228_036_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	036	0	1	04	01	H2228_036_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	036	0	1	04	01	H2228_036_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	036	0	1	04	01	H2228_036_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	037	0	1	04	01	H2228_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	037	0	1	04	01	H2228_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	037	0	1	04	01	H2228_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	037	0	1	04	01	H2228_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	037	0	1	04	01	H2228_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	039	0	1	04	01	H2228_039_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	039	0	1	04	01	H2228_039_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	039	0	1	04	01	H2228_039_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	039	0	1	04	01	H2228_039_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	039	0	1	04	01	H2228_039_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	047	0	1	04	01	H2228_047_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	047	0	1	04	01	H2228_047_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	047	0	1	04	01	H2228_047_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	047	0	1	04	01	H2228_047_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	047	0	1	04	01	H2228_047_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	049	0	1	04	01	H2228_049_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	049	0	1	04	01	H2228_049_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	049	0	1	04	01	H2228_049_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	049	0	1	04	01	H2228_049_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	049	0	1	04	01	H2228_049_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	064	0	1	04	01	H2228_064_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	064	0	1	04	01	H2228_064_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	064	0	1	04	01	H2228_064_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	064	0	1	04	01	H2228_064_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	064	0	1	04	01	H2228_064_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	065	0	1	04	01	H2228_065_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	065	0	1	04	01	H2228_065_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	065	0	1	04	01	H2228_065_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	065	0	1	04	01	H2228_065_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	065	0	1	04	01	H2228_065_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	066	0	1	04	01	H2228_066_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	066	0	1	04	01	H2228_066_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	066	0	1	04	01	H2228_066_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	066	0	1	04	01	H2228_066_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	066	0	1	04	01	H2228_066_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	067	0	1	04	01	H2228_067_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	067	0	1	04	01	H2228_067_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	067	0	1	04	01	H2228_067_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	067	0	1	04	01	H2228_067_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	067	0	1	04	01	H2228_067_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	068	0	1	04	01	H2228_068_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	068	0	1	04	01	H2228_068_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	068	0	1	04	01	H2228_068_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	068	0	1	04	01	H2228_068_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	068	0	1	04	01	H2228_068_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	071	0	1	04	01	H2228_071_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	071	0	1	04	01	H2228_071_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	071	0	1	04	01	H2228_071_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	071	0	1	04	01	H2228_071_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	071	0	1	04	01	H2228_071_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	074	0	1	04	01	H2228_074_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	074	0	1	04	01	H2228_074_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	074	0	1	04	01	H2228_074_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	074	0	1	04	01	H2228_074_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	074	0	1	04	01	H2228_074_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	075	0	1	04	01	H2228_075_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	075	0	1	04	01	H2228_075_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	075	0	1	04	01	H2228_075_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	075	0	1	04	01	H2228_075_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	075	0	1	04	01	H2228_075_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	076	0	1	04	01	H2228_076_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	076	0	1	04	01	H2228_076_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	076	0	1	04	01	H2228_076_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	076	0	1	04	01	H2228_076_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	076	0	1	04	01	H2228_076_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	077	0	1	04	01	H2228_077_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	077	0	1	04	01	H2228_077_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	077	0	1	04	01	H2228_077_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	077	0	1	04	01	H2228_077_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	077	0	1	04	01	H2228_077_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	079	0	1	04	01	H2228_079_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	079	0	1	04	01	H2228_079_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	079	0	1	04	01	H2228_079_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	079	0	1	04	01	H2228_079_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	079	0	1	04	01	H2228_079_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	080	0	1	04	01	H2228_080_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	080	0	1	04	01	H2228_080_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	080	0	1	04	01	H2228_080_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	080	0	1	04	01	H2228_080_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	080	0	1	04	01	H2228_080_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	081	0	1	04	01	H2228_081_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	081	0	1	04	01	H2228_081_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	081	0	1	04	01	H2228_081_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	081	0	1	04	01	H2228_081_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	081	0	1	04	01	H2228_081_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	082	0	1	04	01	H2228_082_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	082	0	1	04	01	H2228_082_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	082	0	1	04	01	H2228_082_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	082	0	1	04	01	H2228_082_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	082	0	1	04	01	H2228_082_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	083	0	1	04	01	H2228_083_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	083	0	1	04	01	H2228_083_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	083	0	1	04	01	H2228_083_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	083	0	1	04	01	H2228_083_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	083	0	1	04	01	H2228_083_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	084	0	1	04	01	H2228_084_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	084	0	1	04	01	H2228_084_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	084	0	1	04	01	H2228_084_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	084	0	1	04	01	H2228_084_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	084	0	1	04	01	H2228_084_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	085	0	1	04	01	H2228_085_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	085	0	1	04	01	H2228_085_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	085	0	1	04	01	H2228_085_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	085	0	1	04	01	H2228_085_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	085	0	1	04	01	H2228_085_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	086	0	1	04	01	H2228_086_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	086	0	1	04	01	H2228_086_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	086	0	1	04	01	H2228_086_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	086	0	1	04	01	H2228_086_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	086	0	1	04	01	H2228_086_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	093	0	1	04	01	H2228_093_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	093	0	1	04	01	H2228_093_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	093	0	1	04	01	H2228_093_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	093	0	1	04	01	H2228_093_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	093	0	1	04	01	H2228_093_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	094	0	1	04	01	H2228_094_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	094	0	1	04	01	H2228_094_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	094	0	1	04	01	H2228_094_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	094	0	1	04	01	H2228_094_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	094	0	1	04	01	H2228_094_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	096	0	1	04	01	H2228_096_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	096	0	1	04	01	H2228_096_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	096	0	1	04	01	H2228_096_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	096	0	1	04	01	H2228_096_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	096	0	1	04	01	H2228_096_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2228	097	0	1	04	01	H2228_097_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2228	097	0	1	04	01	H2228_097_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2228	097	0	1	04	01	H2228_097_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2228	097	0	1	04	01	H2228_097_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2228	097	0	1	04	01	H2228_097_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2230	002	0	1	04	01	H2230_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H2230	002	0	1	04	01	H2230_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H2230	002	0	1	04	01	H2230_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H2230	002	0	1	04	01	H2230_002_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H2230	002	0	1	04	01	H2230_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2230	017	0	1	04	01	H2230_017_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H2230	017	0	1	04	01	H2230_017_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H2230	017	0	1	04	01	H2230_017_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H2230	017	0	1	04	01	H2230_017_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H2230	017	0	1	04	01	H2230_017_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2230	017	0	1	04	01	H2230_017_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H2230	018	1	1	04	01	H2230_018_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H2230	018	1	1	04	01	H2230_018_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H2230	018	1	1	04	01	H2230_018_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H2230	018	1	1	04	01	H2230_018_1	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H2230	018	1	1	04	01	H2230_018_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2230	018	1	1	04	01	H2230_018_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H2230	018	2	1	04	01	H2230_018_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H2230	018	2	1	04	01	H2230_018_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H2230	018	2	1	04	01	H2230_018_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H2230	018	2	1	04	01	H2230_018_2	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H2230	018	2	1	04	01	H2230_018_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2230	018	2	1	04	01	H2230_018_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H2235	001	0	1	01	01	H2235_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2235	001	0	1	01	01	H2235_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	3						
H2235	001	0	1	01	01	H2235_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2235	001	0	1	01	01	H2235_001_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2235	001	0	1	01	01	H2235_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2235	002	0	1	01	01	H2235_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2235	002	0	1	01	01	H2235_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	3						
H2235	002	0	1	01	01	H2235_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2235	002	0	1	01	01	H2235_002_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2235	002	0	1	01	01	H2235_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2235	003	0	1	01	01	H2235_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2235	003	0	1	01	01	H2235_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	3						
H2235	003	0	1	01	01	H2235_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2235	003	0	1	01	01	H2235_003_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2235	003	0	1	01	01	H2235_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2235	004	0	1	01	01	H2235_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2235	004	0	1	01	01	H2235_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	3						
H2235	004	0	1	01	01	H2235_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2235	004	0	1	01	01	H2235_004_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2235	004	0	1	01	01	H2235_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2237	001	0	1	01	01	H2237_001_0	7	Generic	3	Generic, Brand, Specialty Tier	1	2	01	1						
H2237	001	0	1	01	01	H2237_001_0	7	Brand	3	Generic, Brand, Specialty Tier	2	2	10	1						
H2237	001	0	1	01	01	H2237_001_0	7	Specialty Tier	3	Generic, Brand, Specialty Tier	3	2	11	1						
H2237	007	0	1	01	01	H2237_007_0	7	Generic	3	Generic, Brand, Specialty Tier	1	2	01	1						
H2237	007	0	1	01	01	H2237_007_0	7	Brand	3	Generic, Brand, Specialty Tier	2	2	10	1						
H2237	007	0	1	01	01	H2237_007_0	7	Specialty Tier	3	Generic, Brand, Specialty Tier	3	2	11	1						
H2241	007	1	1	01	01	H2241_007_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2241	007	1	1	01	01	H2241_007_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2241	007	1	1	01	01	H2241_007_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2241	007	1	1	01	01	H2241_007_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2241	007	1	1	01	01	H2241_007_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2241	007	2	1	01	01	H2241_007_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2241	007	2	1	01	01	H2241_007_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2241	007	2	1	01	01	H2241_007_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2241	007	2	1	01	01	H2241_007_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2241	007	2	1	01	01	H2241_007_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2241	012	0	1	01	01	H2241_012_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2241	012	0	1	01	01	H2241_012_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2241	012	0	1	01	01	H2241_012_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2241	012	0	1	01	01	H2241_012_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2241	012	0	1	01	01	H2241_012_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2241	013	0	1	01	01	H2241_013_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2241	013	0	1	01	01	H2241_013_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2241	013	0	1	01	01	H2241_013_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2241	013	0	1	01	01	H2241_013_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2241	013	0	1	01	01	H2241_013_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2241	014	0	1	01	01	H2241_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2241	014	0	1	01	01	H2241_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2241	014	0	1	01	01	H2241_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2241	014	0	1	01	01	H2241_014_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2241	014	0	1	01	01	H2241_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2241	015	0	1	01	01	H2241_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2241	015	0	1	01	01	H2241_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2241	015	0	1	01	01	H2241_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2241	015	0	1	01	01	H2241_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2241	015	0	1	01	01	H2241_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2241	016	0	1	01	01	H2241_016_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2241	016	0	1	01	01	H2241_016_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2241	016	0	1	01	01	H2241_016_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2241	016	0	1	01	01	H2241_016_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2241	016	0	1	01	01	H2241_016_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2241	017	0	1	01	01	H2241_017_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2241	017	0	1	01	01	H2241_017_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2241	017	0	1	01	01	H2241_017_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2241	017	0	1	01	01	H2241_017_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2241	017	0	1	01	01	H2241_017_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2241	018	0	1	01	01	H2241_018_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2241	018	0	1	01	01	H2241_018_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H2241	018	0	1	01	01	H2241_018_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2241	018	0	1	01	01	H2241_018_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2241	018	0	1	01	01	H2241_018_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2241	018	0	1	01	01	H2241_018_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2241	019	0	1	01	01	H2241_019_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2241	019	0	1	01	01	H2241_019_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H2241	019	0	1	01	01	H2241_019_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2241	019	0	1	01	01	H2241_019_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2241	019	0	1	01	01	H2241_019_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2241	019	0	1	01	01	H2241_019_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2241	020	0	1	01	01	H2241_020_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2241	020	0	1	01	01	H2241_020_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H2241	020	0	1	01	01	H2241_020_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2241	020	0	1	01	01	H2241_020_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2241	020	0	1	01	01	H2241_020_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2241	020	0	1	01	01	H2241_020_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2241	021	0	1	01	01	H2241_021_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2241	021	0	1	01	01	H2241_021_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H2241	021	0	1	01	01	H2241_021_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2241	021	0	1	01	01	H2241_021_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2241	021	0	1	01	01	H2241_021_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2241	021	0	1	01	01	H2241_021_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2256	001	1	1	01	01	H2256_001_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	001	1	1	01	01	H2256_001_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	001	1	1	01	01	H2256_001_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	001	1	1	01	01	H2256_001_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	001	1	1	01	01	H2256_001_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	001	1	1	01	01	H2256_001_1	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	001	2	1	01	01	H2256_001_2	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	001	2	1	01	01	H2256_001_2	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	001	2	1	01	01	H2256_001_2	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	001	2	1	01	01	H2256_001_2	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	001	2	1	01	01	H2256_001_2	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	001	2	1	01	01	H2256_001_2	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	001	6	1	01	01	H2256_001_6	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	001	6	1	01	01	H2256_001_6	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	001	6	1	01	01	H2256_001_6	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	001	6	1	01	01	H2256_001_6	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	001	6	1	01	01	H2256_001_6	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	001	6	1	01	01	H2256_001_6	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	015	1	1	01	01	H2256_015_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	015	1	1	01	01	H2256_015_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	015	1	1	01	01	H2256_015_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	015	1	1	01	01	H2256_015_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	015	1	1	01	01	H2256_015_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	015	1	1	01	01	H2256_015_1	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	015	2	1	01	01	H2256_015_2	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	015	2	1	01	01	H2256_015_2	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	015	2	1	01	01	H2256_015_2	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	015	2	1	01	01	H2256_015_2	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	015	2	1	01	01	H2256_015_2	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	015	2	1	01	01	H2256_015_2	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	015	6	1	01	01	H2256_015_6	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	015	6	1	01	01	H2256_015_6	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	015	6	1	01	01	H2256_015_6	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	015	6	1	01	01	H2256_015_6	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	015	6	1	01	01	H2256_015_6	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	015	6	1	01	01	H2256_015_6	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	018	1	1	01	01	H2256_018_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	018	1	1	01	01	H2256_018_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	018	1	1	01	01	H2256_018_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	018	1	1	01	01	H2256_018_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	018	1	1	01	01	H2256_018_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	018	1	1	01	01	H2256_018_1	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	018	7	1	01	01	H2256_018_7	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	018	7	1	01	01	H2256_018_7	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	018	7	1	01	01	H2256_018_7	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	018	7	1	01	01	H2256_018_7	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	018	7	1	01	01	H2256_018_7	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	018	7	1	01	01	H2256_018_7	12	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	018	8	1	01	01	H2256_018_8	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	018	8	1	01	01	H2256_018_8	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	018	8	1	01	01	H2256_018_8	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	018	8	1	01	01	H2256_018_8	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	018	8	1	01	01	H2256_018_8	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	018	8	1	01	01	H2256_018_8	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	026	1	1	01	01	H2256_026_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	026	1	1	01	01	H2256_026_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	026	1	1	01	01	H2256_026_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	026	1	1	01	01	H2256_026_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	026	1	1	01	01	H2256_026_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	026	1	1	01	01	H2256_026_1	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	026	2	1	01	01	H2256_026_2	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	026	2	1	01	01	H2256_026_2	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	026	2	1	01	01	H2256_026_2	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	026	2	1	01	01	H2256_026_2	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	026	2	1	01	01	H2256_026_2	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	026	2	1	01	01	H2256_026_2	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	026	3	1	01	01	H2256_026_3	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	026	3	1	01	01	H2256_026_3	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	026	3	1	01	01	H2256_026_3	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	026	3	1	01	01	H2256_026_3	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	026	3	1	01	01	H2256_026_3	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	026	3	1	01	01	H2256_026_3	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	028	0	1	01	01	H2256_028_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	028	0	1	01	01	H2256_028_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	028	0	1	01	01	H2256_028_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	028	0	1	01	01	H2256_028_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	028	0	1	01	01	H2256_028_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	028	0	1	01	01	H2256_028_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	033	0	1	01	01	H2256_033_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	033	0	1	01	01	H2256_033_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	033	0	1	01	01	H2256_033_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	033	0	1	01	01	H2256_033_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	033	0	1	01	01	H2256_033_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	033	0	1	01	01	H2256_033_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	034	0	1	01	01	H2256_034_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	034	0	1	01	01	H2256_034_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	034	0	1	01	01	H2256_034_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	034	0	1	01	01	H2256_034_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	034	0	1	01	01	H2256_034_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	034	0	1	01	01	H2256_034_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2256	036	0	1	01	01	H2256_036_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H2256	036	0	1	01	01	H2256_036_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H2256	036	0	1	01	01	H2256_036_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H2256	036	0	1	01	01	H2256_036_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H2256	036	0	1	01	01	H2256_036_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H2256	036	0	1	01	01	H2256_036_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H2261	005	0	1	01	01	H2261_005_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H2261	005	0	1	01	01	H2261_005_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H2261	005	0	1	01	01	H2261_005_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H2261	005	0	1	01	01	H2261_005_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H2261	005	0	1	01	01	H2261_005_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2261	022	1	1	01	01	H2261_022_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H2261	022	1	1	01	01	H2261_022_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H2261	022	1	1	01	01	H2261_022_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H2261	022	1	1	01	01	H2261_022_1	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H2261	022	1	1	01	01	H2261_022_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2261	022	1	1	01	01	H2261_022_1	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H2261	022	2	1	01	01	H2261_022_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H2261	022	2	1	01	01	H2261_022_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H2261	022	2	1	01	01	H2261_022_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H2261	022	2	1	01	01	H2261_022_2	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H2261	022	2	1	01	01	H2261_022_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2261	022	2	1	01	01	H2261_022_2	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H2261	023	1	1	02	01	H2261_023_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H2261	023	1	1	02	01	H2261_023_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H2261	023	1	1	02	01	H2261_023_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H2261	023	1	1	02	01	H2261_023_1	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H2261	023	1	1	02	01	H2261_023_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2261	023	2	1	02	01	H2261_023_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H2261	023	2	1	02	01	H2261_023_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H2261	023	2	1	02	01	H2261_023_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H2261	023	2	1	02	01	H2261_023_2	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H2261	023	2	1	02	01	H2261_023_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2261	024	0	1	01	01	H2261_024_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H2261	024	0	1	01	01	H2261_024_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H2261	024	0	1	01	01	H2261_024_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H2261	024	0	1	01	01	H2261_024_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H2261	024	0	1	01	01	H2261_024_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2261	024	0	1	01	01	H2261_024_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H2288	001	0	1	01	01	H2288_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2288	001	0	1	01	01	H2288_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2288	001	0	1	01	01	H2288_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2288	001	0	1	01	01	H2288_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2288	001	0	1	01	01	H2288_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2288	001	0	1	01	01	H2288_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H2288	002	0	1	01	01	H2288_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2288	002	0	1	01	01	H2288_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2288	002	0	1	01	01	H2288_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2288	002	0	1	01	01	H2288_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2288	002	0	1	01	01	H2288_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2288	002	0	1	01	01	H2288_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H2288	005	0	1	01	01	H2288_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2288	005	0	1	01	01	H2288_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2288	005	0	1	01	01	H2288_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2288	005	0	1	01	01	H2288_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2288	005	0	1	01	01	H2288_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2288	005	0	1	01	01	H2288_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H2288	009	0	1	01	01	H2288_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2288	009	0	1	01	01	H2288_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2288	009	0	1	01	01	H2288_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2288	009	0	1	01	01	H2288_009_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2288	009	0	1	01	01	H2288_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2288	009	0	1	01	01	H2288_009_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H2288	010	0	1	01	01	H2288_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2288	010	0	1	01	01	H2288_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2288	010	0	1	01	01	H2288_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2288	010	0	1	01	01	H2288_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2288	010	0	1	01	01	H2288_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2288	010	0	1	01	01	H2288_010_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H2292	003	0	1	04	01	H2292_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2292	003	0	1	04	01	H2292_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2292	003	0	1	04	01	H2292_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2292	003	0	1	04	01	H2292_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2292	003	0	1	04	01	H2292_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	022	1	1	02	01	H2320_022_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	022	1	1	02	01	H2320_022_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	022	1	1	02	01	H2320_022_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	022	1	1	02	01	H2320_022_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	022	1	1	02	01	H2320_022_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	022	2	1	02	01	H2320_022_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	022	2	1	02	01	H2320_022_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	022	2	1	02	01	H2320_022_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	022	2	1	02	01	H2320_022_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	022	2	1	02	01	H2320_022_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	022	3	1	02	01	H2320_022_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	022	3	1	02	01	H2320_022_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	022	3	1	02	01	H2320_022_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	022	3	1	02	01	H2320_022_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	022	3	1	02	01	H2320_022_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	022	4	1	02	01	H2320_022_4	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	022	4	1	02	01	H2320_022_4	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	022	4	1	02	01	H2320_022_4	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	022	4	1	02	01	H2320_022_4	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	022	4	1	02	01	H2320_022_4	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	022	5	1	02	01	H2320_022_5	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	022	5	1	02	01	H2320_022_5	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	022	5	1	02	01	H2320_022_5	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	022	5	1	02	01	H2320_022_5	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	022	5	1	02	01	H2320_022_5	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	028	1	1	02	01	H2320_028_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	028	1	1	02	01	H2320_028_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	028	1	1	02	01	H2320_028_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	028	1	1	02	01	H2320_028_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	028	1	1	02	01	H2320_028_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	028	2	1	02	01	H2320_028_2	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	028	2	1	02	01	H2320_028_2	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	028	2	1	02	01	H2320_028_2	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	028	2	1	02	01	H2320_028_2	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	028	2	1	02	01	H2320_028_2	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	028	3	1	02	01	H2320_028_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	028	3	1	02	01	H2320_028_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	028	3	1	02	01	H2320_028_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	028	3	1	02	01	H2320_028_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	028	3	1	02	01	H2320_028_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	028	4	1	02	01	H2320_028_4	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	028	4	1	02	01	H2320_028_4	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	028	4	1	02	01	H2320_028_4	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	028	4	1	02	01	H2320_028_4	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	028	4	1	02	01	H2320_028_4	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	028	5	1	02	01	H2320_028_5	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	028	5	1	02	01	H2320_028_5	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	028	5	1	02	01	H2320_028_5	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	028	5	1	02	01	H2320_028_5	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	028	5	1	02	01	H2320_028_5	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	029	1	1	02	01	H2320_029_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	029	1	1	02	01	H2320_029_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	029	1	1	02	01	H2320_029_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	029	1	1	02	01	H2320_029_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	029	1	1	02	01	H2320_029_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	029	2	1	02	01	H2320_029_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	029	2	1	02	01	H2320_029_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	029	2	1	02	01	H2320_029_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	029	2	1	02	01	H2320_029_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	029	2	1	02	01	H2320_029_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	029	3	1	02	01	H2320_029_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	029	3	1	02	01	H2320_029_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	029	3	1	02	01	H2320_029_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	029	3	1	02	01	H2320_029_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	029	3	1	02	01	H2320_029_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	029	4	1	02	01	H2320_029_4	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	029	4	1	02	01	H2320_029_4	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	029	4	1	02	01	H2320_029_4	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	029	4	1	02	01	H2320_029_4	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	029	4	1	02	01	H2320_029_4	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2320	029	5	1	02	01	H2320_029_5	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2320	029	5	1	02	01	H2320_029_5	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2320	029	5	1	02	01	H2320_029_5	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2320	029	5	1	02	01	H2320_029_5	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2320	029	5	1	02	01	H2320_029_5	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2322	004	0	1	04	01	H2322_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2322	004	0	1	04	01	H2322_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2322	004	0	1	04	01	H2322_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2322	004	0	1	04	01	H2322_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2322	004	0	1	04	01	H2322_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2322	004	0	1	04	01	H2322_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2322	008	0	1	04	01	H2322_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2322	008	0	1	04	01	H2322_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2322	008	0	1	04	01	H2322_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2322	008	0	1	04	01	H2322_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2322	008	0	1	04	01	H2322_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2322	008	0	1	04	01	H2322_008_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2322	011	0	1	04	01	H2322_011_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2322	011	0	1	04	01	H2322_011_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2322	011	0	1	04	01	H2322_011_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2322	011	0	1	04	01	H2322_011_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2322	011	0	1	04	01	H2322_011_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2322	011	0	1	04	01	H2322_011_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2322	012	0	1	04	01	H2322_012_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2322	012	0	1	04	01	H2322_012_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2322	012	0	1	04	01	H2322_012_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2322	012	0	1	04	01	H2322_012_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2322	012	0	1	04	01	H2322_012_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2322	012	0	1	04	01	H2322_012_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2334	003	0	1	04	01	H2334_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2334	003	0	1	04	01	H2334_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2334	003	0	1	04	01	H2334_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2334	003	0	1	04	01	H2334_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2334	003	0	1	04	01	H2334_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2334	005	0	1	04	01	H2334_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2334	005	0	1	04	01	H2334_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2334	005	0	1	04	01	H2334_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2334	005	0	1	04	01	H2334_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2334	005	0	1	04	01	H2334_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2354	015	0	1	01	01	H2354_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2354	015	0	1	01	01	H2354_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2354	015	0	1	01	01	H2354_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2354	015	0	1	01	01	H2354_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2354	015	0	1	01	01	H2354_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2354	015	0	1	01	01	H2354_015_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2354	018	0	1	01	01	H2354_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2354	018	0	1	01	01	H2354_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2354	018	0	1	01	01	H2354_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2354	018	0	1	01	01	H2354_018_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2354	018	0	1	01	01	H2354_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2354	018	0	1	01	01	H2354_018_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2354	021	0	1	02	01	H2354_021_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2354	021	0	1	02	01	H2354_021_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2354	021	0	1	02	01	H2354_021_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2354	021	0	1	02	01	H2354_021_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2354	021	0	1	02	01	H2354_021_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2354	021	0	1	02	01	H2354_021_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2354	022	0	1	02	01	H2354_022_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2354	022	0	1	02	01	H2354_022_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2354	022	0	1	02	01	H2354_022_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2354	022	0	1	02	01	H2354_022_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2354	022	0	1	02	01	H2354_022_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2354	022	0	1	02	01	H2354_022_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2354	024	0	1	01	01	H2354_024_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2354	024	0	1	01	01	H2354_024_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2354	024	0	1	01	01	H2354_024_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2354	024	0	1	01	01	H2354_024_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2354	024	0	1	01	01	H2354_024_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2354	024	0	1	01	01	H2354_024_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2354	026	0	1	01	01	H2354_026_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2354	026	0	1	01	01	H2354_026_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2354	026	0	1	01	01	H2354_026_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2354	026	0	1	01	01	H2354_026_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2354	026	0	1	01	01	H2354_026_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2354	026	0	1	01	01	H2354_026_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2354	027	0	1	01	01	H2354_027_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2354	027	0	1	01	01	H2354_027_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2354	027	0	1	01	01	H2354_027_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	3						
H2354	027	0	1	01	01	H2354_027_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2354	027	0	1	01	01	H2354_027_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2354	027	0	1	01	01	H2354_027_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2392	002	0	1	01	01	H2392_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2392	002	0	1	01	01	H2392_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2392	002	0	1	01	01	H2392_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2392	002	0	1	01	01	H2392_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2392	002	0	1	01	01	H2392_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	008	0	1	04	01	H2406_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	008	0	1	04	01	H2406_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	008	0	1	04	01	H2406_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	008	0	1	04	01	H2406_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	008	0	1	04	01	H2406_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	009	0	1	04	01	H2406_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	009	0	1	04	01	H2406_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	009	0	1	04	01	H2406_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	009	0	1	04	01	H2406_009_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	009	0	1	04	01	H2406_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	010	0	1	04	01	H2406_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	010	0	1	04	01	H2406_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	010	0	1	04	01	H2406_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	010	0	1	04	01	H2406_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	010	0	1	04	01	H2406_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	011	0	1	04	01	H2406_011_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	011	0	1	04	01	H2406_011_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	011	0	1	04	01	H2406_011_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	011	0	1	04	01	H2406_011_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	011	0	1	04	01	H2406_011_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	012	0	1	04	01	H2406_012_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	012	0	1	04	01	H2406_012_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	012	0	1	04	01	H2406_012_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	012	0	1	04	01	H2406_012_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	012	0	1	04	01	H2406_012_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	013	0	1	04	01	H2406_013_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	013	0	1	04	01	H2406_013_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	013	0	1	04	01	H2406_013_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	013	0	1	04	01	H2406_013_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	013	0	1	04	01	H2406_013_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	014	0	1	04	01	H2406_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	014	0	1	04	01	H2406_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	014	0	1	04	01	H2406_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	014	0	1	04	01	H2406_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	014	0	1	04	01	H2406_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	015	0	1	04	01	H2406_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	015	0	1	04	01	H2406_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	015	0	1	04	01	H2406_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	015	0	1	04	01	H2406_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	015	0	1	04	01	H2406_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	016	0	1	04	01	H2406_016_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	016	0	1	04	01	H2406_016_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	016	0	1	04	01	H2406_016_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	016	0	1	04	01	H2406_016_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	016	0	1	04	01	H2406_016_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	017	0	1	04	01	H2406_017_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	017	0	1	04	01	H2406_017_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	017	0	1	04	01	H2406_017_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	017	0	1	04	01	H2406_017_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	017	0	1	04	01	H2406_017_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	018	0	1	04	01	H2406_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	018	0	1	04	01	H2406_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	018	0	1	04	01	H2406_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	018	0	1	04	01	H2406_018_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	018	0	1	04	01	H2406_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2406	019	0	1	04	01	H2406_019_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2406	019	0	1	04	01	H2406_019_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2406	019	0	1	04	01	H2406_019_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2406	019	0	1	04	01	H2406_019_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2406	019	0	1	04	01	H2406_019_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	001	0	1	18	06	H2450_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	001	0	1	18	06	H2450_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	001	0	1	18	06	H2450_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	001	0	1	18	06	H2450_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	001	0	1	18	06	H2450_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	002	0	1	18	06	H2450_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	002	0	1	18	06	H2450_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	002	0	1	18	06	H2450_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	002	0	1	18	06	H2450_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	002	0	1	18	06	H2450_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	007	0	1	18	06	H2450_007_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	007	0	1	18	06	H2450_007_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	007	0	1	18	06	H2450_007_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	007	0	1	18	06	H2450_007_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	007	0	1	18	06	H2450_007_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	016	0	1	18	06	H2450_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	016	0	1	18	06	H2450_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	016	0	1	18	06	H2450_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	016	0	1	18	06	H2450_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	016	0	1	18	06	H2450_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	017	0	1	18	06	H2450_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	017	0	1	18	06	H2450_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	017	0	1	18	06	H2450_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	017	0	1	18	06	H2450_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	017	0	1	18	06	H2450_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	022	0	1	18	06	H2450_022_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	022	0	1	18	06	H2450_022_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	022	0	1	18	06	H2450_022_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	022	0	1	18	06	H2450_022_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	022	0	1	18	06	H2450_022_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	035	0	1	18	06	H2450_035_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	035	0	1	18	06	H2450_035_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	035	0	1	18	06	H2450_035_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	035	0	1	18	06	H2450_035_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	035	0	1	18	06	H2450_035_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	037	0	1	18	06	H2450_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	037	0	1	18	06	H2450_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	037	0	1	18	06	H2450_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	037	0	1	18	06	H2450_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	037	0	1	18	06	H2450_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	039	0	1	18	06	H2450_039_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	039	0	1	18	06	H2450_039_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	039	0	1	18	06	H2450_039_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	039	0	1	18	06	H2450_039_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	039	0	1	18	06	H2450_039_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	041	0	1	18	06	H2450_041_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	041	0	1	18	06	H2450_041_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	041	0	1	18	06	H2450_041_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	041	0	1	18	06	H2450_041_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	041	0	1	18	06	H2450_041_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2450	049	0	1	18	06	H2450_049_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2450	049	0	1	18	06	H2450_049_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2450	049	0	1	18	06	H2450_049_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2450	049	0	1	18	06	H2450_049_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2450	049	0	1	18	06	H2450_049_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	020	0	1	02	01	H2459_020_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	020	0	1	02	01	H2459_020_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	020	0	1	02	01	H2459_020_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	020	0	1	02	01	H2459_020_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	020	0	1	02	01	H2459_020_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	021	1	1	02	01	H2459_021_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	021	1	1	02	01	H2459_021_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	021	1	1	02	01	H2459_021_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	021	1	1	02	01	H2459_021_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	021	1	1	02	01	H2459_021_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	021	2	1	02	01	H2459_021_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	021	2	1	02	01	H2459_021_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	021	2	1	02	01	H2459_021_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	021	2	1	02	01	H2459_021_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	021	2	1	02	01	H2459_021_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	021	3	1	02	01	H2459_021_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	021	3	1	02	01	H2459_021_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	021	3	1	02	01	H2459_021_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	021	3	1	02	01	H2459_021_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	021	3	1	02	01	H2459_021_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	023	1	1	02	01	H2459_023_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	023	1	1	02	01	H2459_023_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	023	1	1	02	01	H2459_023_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	023	1	1	02	01	H2459_023_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	023	1	1	02	01	H2459_023_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	023	2	1	02	01	H2459_023_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	023	2	1	02	01	H2459_023_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	023	2	1	02	01	H2459_023_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	023	2	1	02	01	H2459_023_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	023	2	1	02	01	H2459_023_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	024	0	1	02	01	H2459_024_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	024	0	1	02	01	H2459_024_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	024	0	1	02	01	H2459_024_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	024	0	1	02	01	H2459_024_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	024	0	1	02	01	H2459_024_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	026	1	1	02	01	H2459_026_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	026	1	1	02	01	H2459_026_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	026	1	1	02	01	H2459_026_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	026	1	1	02	01	H2459_026_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	026	1	1	02	01	H2459_026_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	026	3	1	02	01	H2459_026_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	026	3	1	02	01	H2459_026_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	026	3	1	02	01	H2459_026_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	026	3	1	02	01	H2459_026_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	026	3	1	02	01	H2459_026_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	026	4	1	02	01	H2459_026_4	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	026	4	1	02	01	H2459_026_4	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	026	4	1	02	01	H2459_026_4	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	026	4	1	02	01	H2459_026_4	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	026	4	1	02	01	H2459_026_4	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	028	0	1	02	01	H2459_028_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	028	0	1	02	01	H2459_028_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	028	0	1	02	01	H2459_028_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	028	0	1	02	01	H2459_028_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	028	0	1	02	01	H2459_028_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	029	0	1	02	01	H2459_029_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	029	0	1	02	01	H2459_029_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	029	0	1	02	01	H2459_029_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	029	0	1	02	01	H2459_029_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	029	0	1	02	01	H2459_029_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	031	0	1	01	01	H2459_031_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	031	0	1	01	01	H2459_031_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	031	0	1	01	01	H2459_031_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	031	0	1	01	01	H2459_031_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	031	0	1	01	01	H2459_031_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2459	032	0	1	01	01	H2459_032_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2459	032	0	1	01	01	H2459_032_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2459	032	0	1	01	01	H2459_032_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2459	032	0	1	01	01	H2459_032_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2459	032	0	1	01	01	H2459_032_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2461	008	0	1	18	06	H2461_008_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2461	008	0	1	18	06	H2461_008_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2461	008	0	1	18	06	H2461_008_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2461	008	0	1	18	06	H2461_008_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2461	008	0	1	18	06	H2461_008_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2461	009	0	1	18	06	H2461_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2461	009	0	1	18	06	H2461_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2461	009	0	1	18	06	H2461_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2461	009	0	1	18	06	H2461_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2461	009	0	1	18	06	H2461_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2461	010	0	1	18	06	H2461_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2461	010	0	1	18	06	H2461_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2461	010	0	1	18	06	H2461_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2461	010	0	1	18	06	H2461_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2461	010	0	1	18	06	H2461_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2463	001	0	1	01	01	H2463_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2463	001	0	1	01	01	H2463_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2463	001	0	1	01	01	H2463_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2463	001	0	1	01	01	H2463_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2463	001	0	1	01	01	H2463_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2486	003	0	1	01	01	H2486_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2486	003	0	1	01	01	H2486_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2486	003	0	1	01	01	H2486_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2486	003	0	1	01	01	H2486_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2486	003	0	1	01	01	H2486_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2486	005	0	1	01	01	H2486_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2486	005	0	1	01	01	H2486_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2486	005	0	1	01	01	H2486_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2486	005	0	1	01	01	H2486_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2486	005	0	1	01	01	H2486_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2486	006	0	1	01	01	H2486_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2486	006	0	1	01	01	H2486_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2486	006	0	1	01	01	H2486_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2486	006	0	1	01	01	H2486_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2486	006	0	1	01	01	H2486_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2486	007	0	1	01	01	H2486_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2486	007	0	1	01	01	H2486_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2486	007	0	1	01	01	H2486_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2486	007	0	1	01	01	H2486_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2486	007	0	1	01	01	H2486_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2486	008	0	1	01	01	H2486_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2486	008	0	1	01	01	H2486_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2486	008	0	1	01	01	H2486_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2486	008	0	1	01	01	H2486_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2486	008	0	1	01	01	H2486_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	004	0	1	01	01	H2491_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	004	0	1	01	01	H2491_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	004	0	1	01	01	H2491_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	004	0	1	01	01	H2491_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	004	0	1	01	01	H2491_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	006	0	1	01	01	H2491_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	006	0	1	01	01	H2491_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	006	0	1	01	01	H2491_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	006	0	1	01	01	H2491_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	006	0	1	01	01	H2491_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	007	0	1	01	01	H2491_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	007	0	1	01	01	H2491_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	007	0	1	01	01	H2491_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	007	0	1	01	01	H2491_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	007	0	1	01	01	H2491_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	008	0	1	01	01	H2491_008_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	008	0	1	01	01	H2491_008_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	008	0	1	01	01	H2491_008_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	008	0	1	01	01	H2491_008_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	008	0	1	01	01	H2491_008_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	009	0	1	01	01	H2491_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	009	0	1	01	01	H2491_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	009	0	1	01	01	H2491_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	009	0	1	01	01	H2491_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	009	0	1	01	01	H2491_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	010	0	1	01	01	H2491_010_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	010	0	1	01	01	H2491_010_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	010	0	1	01	01	H2491_010_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	010	0	1	01	01	H2491_010_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	010	0	1	01	01	H2491_010_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	011	0	1	01	01	H2491_011_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	011	0	1	01	01	H2491_011_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	011	0	1	01	01	H2491_011_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	011	0	1	01	01	H2491_011_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	011	0	1	01	01	H2491_011_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	012	0	1	01	01	H2491_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	012	0	1	01	01	H2491_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	012	0	1	01	01	H2491_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	012	0	1	01	01	H2491_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	012	0	1	01	01	H2491_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	013	0	1	01	01	H2491_013_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	013	0	1	01	01	H2491_013_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	013	0	1	01	01	H2491_013_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	013	0	1	01	01	H2491_013_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	013	0	1	01	01	H2491_013_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	014	0	1	01	01	H2491_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	014	0	1	01	01	H2491_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	014	0	1	01	01	H2491_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	014	0	1	01	01	H2491_014_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	014	0	1	01	01	H2491_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	015	0	1	01	01	H2491_015_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	015	0	1	01	01	H2491_015_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	015	0	1	01	01	H2491_015_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	015	0	1	01	01	H2491_015_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	015	0	1	01	01	H2491_015_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2491	016	0	1	01	01	H2491_016_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2491	016	0	1	01	01	H2491_016_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2491	016	0	1	01	01	H2491_016_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2491	016	0	1	01	01	H2491_016_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2491	016	0	1	01	01	H2491_016_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2506	001	0	1	48	05	H2506_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	11					1	0.00	0.00
H2506	001	0	1	48	05	H2506_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H2506	001	0	1	48	05	H2506_001_0	3	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H2531	001	0	1	48	05	H2531_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H2531	001	0	1	48	05	H2531_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H2531	001	0	1	48	05	H2531_001_0	3	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H2533	001	0	1	48	05	H2533_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H2533	001	0	1	48	05	H2533_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H2533	001	0	1	48	05	H2533_001_0	3	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H2563	005	1	1	01	01	H2563_005_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	005	1	1	01	01	H2563_005_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	005	1	1	01	01	H2563_005_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	005	1	1	01	01	H2563_005_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	005	1	1	01	01	H2563_005_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2563	005	2	1	01	01	H2563_005_2	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	005	2	1	01	01	H2563_005_2	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	005	2	1	01	01	H2563_005_2	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	005	2	1	01	01	H2563_005_2	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	005	2	1	01	01	H2563_005_2	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2563	008	0	1	01	01	H2563_008_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	008	0	1	01	01	H2563_008_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	008	0	1	01	01	H2563_008_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	008	0	1	01	01	H2563_008_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	008	0	1	01	01	H2563_008_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2563	009	0	1	01	01	H2563_009_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	009	0	1	01	01	H2563_009_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	009	0	1	01	01	H2563_009_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	009	0	1	01	01	H2563_009_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	009	0	1	01	01	H2563_009_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2563	012	0	1	01	01	H2563_012_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	012	0	1	01	01	H2563_012_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	012	0	1	01	01	H2563_012_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	012	0	1	01	01	H2563_012_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	012	0	1	01	01	H2563_012_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2563	013	0	1	01	01	H2563_013_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	013	0	1	01	01	H2563_013_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	013	0	1	01	01	H2563_013_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	013	0	1	01	01	H2563_013_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	013	0	1	01	01	H2563_013_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2563	015	0	1	01	01	H2563_015_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	015	0	1	01	01	H2563_015_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	015	0	1	01	01	H2563_015_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	015	0	1	01	01	H2563_015_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	015	0	1	01	01	H2563_015_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2563	016	0	1	01	01	H2563_016_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	016	0	1	01	01	H2563_016_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	016	0	1	01	01	H2563_016_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	016	0	1	01	01	H2563_016_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	016	0	1	01	01	H2563_016_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2563	017	1	1	01	01	H2563_017_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	017	1	1	01	01	H2563_017_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	017	1	1	01	01	H2563_017_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	017	1	1	01	01	H2563_017_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	017	1	1	01	01	H2563_017_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2563	017	2	1	01	01	H2563_017_2	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2563	017	2	1	01	01	H2563_017_2	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2563	017	2	1	01	01	H2563_017_2	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H2563	017	2	1	01	01	H2563_017_2	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2563	017	2	1	01	01	H2563_017_2	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	001	1	1	04	01	H2577_001_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	001	1	1	04	01	H2577_001_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	001	1	1	04	01	H2577_001_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	001	1	1	04	01	H2577_001_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	001	1	1	04	01	H2577_001_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	001	2	1	04	01	H2577_001_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	001	2	1	04	01	H2577_001_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	001	2	1	04	01	H2577_001_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	001	2	1	04	01	H2577_001_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	001	2	1	04	01	H2577_001_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	002	0	1	04	01	H2577_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	002	0	1	04	01	H2577_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	002	0	1	04	01	H2577_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	002	0	1	04	01	H2577_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	002	0	1	04	01	H2577_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	003	1	1	04	01	H2577_003_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	003	1	1	04	01	H2577_003_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	003	1	1	04	01	H2577_003_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	003	1	1	04	01	H2577_003_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	003	1	1	04	01	H2577_003_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	003	2	1	04	01	H2577_003_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	003	2	1	04	01	H2577_003_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	003	2	1	04	01	H2577_003_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	003	2	1	04	01	H2577_003_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	003	2	1	04	01	H2577_003_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	004	0	1	04	01	H2577_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	004	0	1	04	01	H2577_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	004	0	1	04	01	H2577_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	004	0	1	04	01	H2577_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	004	0	1	04	01	H2577_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	005	0	1	04	01	H2577_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	005	0	1	04	01	H2577_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	005	0	1	04	01	H2577_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	005	0	1	04	01	H2577_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	005	0	1	04	01	H2577_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	006	0	1	04	01	H2577_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	006	0	1	04	01	H2577_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	006	0	1	04	01	H2577_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	006	0	1	04	01	H2577_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	006	0	1	04	01	H2577_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	007	0	1	04	01	H2577_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	007	0	1	04	01	H2577_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	007	0	1	04	01	H2577_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	007	0	1	04	01	H2577_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	007	0	1	04	01	H2577_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	008	0	1	04	01	H2577_008_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	008	0	1	04	01	H2577_008_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	008	0	1	04	01	H2577_008_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	008	0	1	04	01	H2577_008_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	008	0	1	04	01	H2577_008_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	009	0	1	04	01	H2577_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	009	0	1	04	01	H2577_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	009	0	1	04	01	H2577_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	009	0	1	04	01	H2577_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	009	0	1	04	01	H2577_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	011	0	1	04	01	H2577_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	011	0	1	04	01	H2577_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	011	0	1	04	01	H2577_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	011	0	1	04	01	H2577_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	011	0	1	04	01	H2577_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	013	0	1	04	01	H2577_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	013	0	1	04	01	H2577_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	013	0	1	04	01	H2577_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	013	0	1	04	01	H2577_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	013	0	1	04	01	H2577_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	014	0	1	04	01	H2577_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	014	0	1	04	01	H2577_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	014	0	1	04	01	H2577_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	014	0	1	04	01	H2577_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	014	0	1	04	01	H2577_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	016	0	1	04	01	H2577_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	016	0	1	04	01	H2577_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	016	0	1	04	01	H2577_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	016	0	1	04	01	H2577_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	016	0	1	04	01	H2577_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	017	0	1	04	01	H2577_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	017	0	1	04	01	H2577_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	017	0	1	04	01	H2577_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	017	0	1	04	01	H2577_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	017	0	1	04	01	H2577_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	018	0	1	04	01	H2577_018_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	018	0	1	04	01	H2577_018_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	018	0	1	04	01	H2577_018_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	018	0	1	04	01	H2577_018_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	018	0	1	04	01	H2577_018_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	020	0	1	04	01	H2577_020_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	020	0	1	04	01	H2577_020_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	020	0	1	04	01	H2577_020_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	020	0	1	04	01	H2577_020_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	020	0	1	04	01	H2577_020_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2577	021	0	1	04	01	H2577_021_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2577	021	0	1	04	01	H2577_021_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2577	021	0	1	04	01	H2577_021_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2577	021	0	1	04	01	H2577_021_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2577	021	0	1	04	01	H2577_021_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2582	004	0	1	01	01	H2582_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2582	004	0	1	01	01	H2582_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2582	004	0	1	01	01	H2582_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2582	004	0	1	01	01	H2582_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2582	004	0	1	01	01	H2582_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2582	005	0	1	01	01	H2582_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2582	005	0	1	01	01	H2582_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2582	005	0	1	01	01	H2582_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2582	005	0	1	01	01	H2582_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2582	005	0	1	01	01	H2582_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2593	001	0	1	01	01	H2593_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	001	0	1	01	01	H2593_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	001	0	1	01	01	H2593_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	001	0	1	01	01	H2593_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	001	0	1	01	01	H2593_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	001	0	1	01	01	H2593_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	003	0	1	01	01	H2593_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	003	0	1	01	01	H2593_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	003	0	1	01	01	H2593_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	003	0	1	01	01	H2593_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	003	0	1	01	01	H2593_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	003	0	1	01	01	H2593_003_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	005	0	1	01	01	H2593_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	005	0	1	01	01	H2593_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	005	0	1	01	01	H2593_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	005	0	1	01	01	H2593_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	005	0	1	01	01	H2593_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	005	0	1	01	01	H2593_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	006	0	1	01	01	H2593_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	006	0	1	01	01	H2593_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	006	0	1	01	01	H2593_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	006	0	1	01	01	H2593_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	006	0	1	01	01	H2593_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	006	0	1	01	01	H2593_006_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	013	0	1	01	01	H2593_013_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	013	0	1	01	01	H2593_013_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	013	0	1	01	01	H2593_013_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	013	0	1	01	01	H2593_013_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	013	0	1	01	01	H2593_013_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	013	0	1	01	01	H2593_013_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	018	0	1	01	01	H2593_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	018	0	1	01	01	H2593_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	018	0	1	01	01	H2593_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	018	0	1	01	01	H2593_018_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	018	0	1	01	01	H2593_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	018	0	1	01	01	H2593_018_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	019	0	1	01	01	H2593_019_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	019	0	1	01	01	H2593_019_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	019	0	1	01	01	H2593_019_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	019	0	1	01	01	H2593_019_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	021	0	1	01	01	H2593_021_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	021	0	1	01	01	H2593_021_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	021	0	1	01	01	H2593_021_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	021	0	1	01	01	H2593_021_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	021	0	1	01	01	H2593_021_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	021	0	1	01	01	H2593_021_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	022	0	1	01	01	H2593_022_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	022	0	1	01	01	H2593_022_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	022	0	1	01	01	H2593_022_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	022	0	1	01	01	H2593_022_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	022	0	1	01	01	H2593_022_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	022	0	1	01	01	H2593_022_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	023	0	1	01	01	H2593_023_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	023	0	1	01	01	H2593_023_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	023	0	1	01	01	H2593_023_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	023	0	1	01	01	H2593_023_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	023	0	1	01	01	H2593_023_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	023	0	1	01	01	H2593_023_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	024	0	1	01	01	H2593_024_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	024	0	1	01	01	H2593_024_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	024	0	1	01	01	H2593_024_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	024	0	1	01	01	H2593_024_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	024	0	1	01	01	H2593_024_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	024	0	1	01	01	H2593_024_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	025	0	1	01	01	H2593_025_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	025	0	1	01	01	H2593_025_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	025	0	1	01	01	H2593_025_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	025	0	1	01	01	H2593_025_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	025	0	1	01	01	H2593_025_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	025	0	1	01	01	H2593_025_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	026	0	1	01	01	H2593_026_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2593	026	0	1	01	01	H2593_026_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	026	0	1	01	01	H2593_026_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	026	0	1	01	01	H2593_026_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	026	0	1	01	01	H2593_026_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	026	0	1	01	01	H2593_026_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	027	0	1	01	01	H2593_027_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	027	0	1	01	01	H2593_027_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	027	0	1	01	01	H2593_027_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	027	0	1	01	01	H2593_027_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	027	0	1	01	01	H2593_027_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	027	0	1	01	01	H2593_027_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	028	1	1	01	01	H2593_028_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	028	1	1	01	01	H2593_028_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	028	1	1	01	01	H2593_028_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	028	1	1	01	01	H2593_028_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	028	1	1	01	01	H2593_028_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	028	1	1	01	01	H2593_028_1	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	028	2	1	01	01	H2593_028_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	028	2	1	01	01	H2593_028_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	028	2	1	01	01	H2593_028_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	028	2	1	01	01	H2593_028_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	028	2	1	01	01	H2593_028_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	028	2	1	01	01	H2593_028_2	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	028	3	1	01	01	H2593_028_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	028	3	1	01	01	H2593_028_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	028	3	1	01	01	H2593_028_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	028	3	1	01	01	H2593_028_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	028	3	1	01	01	H2593_028_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	028	3	1	01	01	H2593_028_3	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	028	4	1	01	01	H2593_028_4	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	028	4	1	01	01	H2593_028_4	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	028	4	1	01	01	H2593_028_4	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	028	4	1	01	01	H2593_028_4	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	028	4	1	01	01	H2593_028_4	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	028	4	1	01	01	H2593_028_4	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	028	5	1	01	01	H2593_028_5	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	028	5	1	01	01	H2593_028_5	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	028	5	1	01	01	H2593_028_5	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	028	5	1	01	01	H2593_028_5	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	028	5	1	01	01	H2593_028_5	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	028	5	1	01	01	H2593_028_5	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	028	6	1	01	01	H2593_028_6	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	028	6	1	01	01	H2593_028_6	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	028	6	1	01	01	H2593_028_6	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	028	6	1	01	01	H2593_028_6	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	028	6	1	01	01	H2593_028_6	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	028	6	1	01	01	H2593_028_6	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	029	0	1	01	01	H2593_029_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2593	029	0	1	01	01	H2593_029_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	029	0	1	01	01	H2593_029_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	029	0	1	01	01	H2593_029_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	029	0	1	01	01	H2593_029_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	029	0	1	01	01	H2593_029_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	030	1	1	01	01	H2593_030_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2593	030	1	1	01	01	H2593_030_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	030	1	1	01	01	H2593_030_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	030	1	1	01	01	H2593_030_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	030	1	1	01	01	H2593_030_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	030	1	1	01	01	H2593_030_1	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	030	2	1	01	01	H2593_030_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2593	030	2	1	01	01	H2593_030_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	030	2	1	01	01	H2593_030_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	030	2	1	01	01	H2593_030_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	030	2	1	01	01	H2593_030_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	030	2	1	01	01	H2593_030_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	030	3	1	01	01	H2593_030_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2593	030	3	1	01	01	H2593_030_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	030	3	1	01	01	H2593_030_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	030	3	1	01	01	H2593_030_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	030	3	1	01	01	H2593_030_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	030	3	1	01	01	H2593_030_3	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	030	4	1	01	01	H2593_030_4	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2593	030	4	1	01	01	H2593_030_4	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	030	4	1	01	01	H2593_030_4	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	030	4	1	01	01	H2593_030_4	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	030	4	1	01	01	H2593_030_4	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	030	4	1	01	01	H2593_030_4	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	030	5	1	01	01	H2593_030_5	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2593	030	5	1	01	01	H2593_030_5	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	030	5	1	01	01	H2593_030_5	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	030	5	1	01	01	H2593_030_5	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	030	5	1	01	01	H2593_030_5	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	030	5	1	01	01	H2593_030_5	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	030	6	1	01	01	H2593_030_6	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2593	030	6	1	01	01	H2593_030_6	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	030	6	1	01	01	H2593_030_6	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	030	6	1	01	01	H2593_030_6	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	030	6	1	01	01	H2593_030_6	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	030	6	1	01	01	H2593_030_6	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	031	0	1	02	01	H2593_031_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	031	0	1	02	01	H2593_031_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	031	0	1	02	01	H2593_031_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	031	0	1	02	01	H2593_031_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	031	0	1	02	01	H2593_031_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	031	0	1	02	01	H2593_031_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	032	0	1	01	01	H2593_032_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H2593	032	0	1	01	01	H2593_032_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	032	0	1	01	01	H2593_032_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	032	0	1	01	01	H2593_032_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	032	0	1	01	01	H2593_032_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	032	0	1	01	01	H2593_032_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	033	0	1	01	01	H2593_033_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	033	0	1	01	01	H2593_033_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	033	0	1	01	01	H2593_033_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	033	0	1	01	01	H2593_033_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	033	0	1	01	01	H2593_033_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	033	0	1	01	01	H2593_033_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	034	0	1	01	01	H2593_034_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	034	0	1	01	01	H2593_034_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	034	0	1	01	01	H2593_034_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	034	0	1	01	01	H2593_034_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	034	0	1	01	01	H2593_034_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	034	0	1	01	01	H2593_034_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	035	0	1	01	01	H2593_035_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	035	0	1	01	01	H2593_035_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	035	0	1	01	01	H2593_035_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	035	0	1	01	01	H2593_035_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	035	0	1	01	01	H2593_035_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	035	0	1	01	01	H2593_035_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	036	0	1	01	01	H2593_036_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2593	036	0	1	01	01	H2593_036_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2593	036	0	1	01	01	H2593_036_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2593	036	0	1	01	01	H2593_036_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2593	036	0	1	01	01	H2593_036_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2593	036	0	1	01	01	H2593_036_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2593	037	0	1	01	01	H2593_037_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	037	0	1	01	01	H2593_037_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	037	0	1	01	01	H2593_037_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	037	0	1	01	01	H2593_037_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	037	0	1	01	01	H2593_037_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	037	0	1	01	01	H2593_037_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	038	0	1	01	01	H2593_038_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	038	0	1	01	01	H2593_038_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	038	0	1	01	01	H2593_038_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	038	0	1	01	01	H2593_038_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	038	0	1	01	01	H2593_038_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	038	0	1	01	01	H2593_038_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	039	0	1	01	01	H2593_039_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	039	0	1	01	01	H2593_039_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	039	0	1	01	01	H2593_039_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	039	0	1	01	01	H2593_039_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	039	0	1	01	01	H2593_039_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	039	0	1	01	01	H2593_039_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	040	0	1	01	01	H2593_040_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	040	0	1	01	01	H2593_040_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	040	0	1	01	01	H2593_040_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	040	0	1	01	01	H2593_040_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	040	0	1	01	01	H2593_040_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	040	0	1	01	01	H2593_040_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	041	0	1	01	01	H2593_041_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	041	0	1	01	01	H2593_041_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	041	0	1	01	01	H2593_041_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	041	0	1	01	01	H2593_041_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	041	0	1	01	01	H2593_041_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	041	0	1	01	01	H2593_041_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2593	042	0	1	01	01	H2593_042_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H2593	042	0	1	01	01	H2593_042_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H2593	042	0	1	01	01	H2593_042_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H2593	042	0	1	01	01	H2593_042_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H2593	042	0	1	01	01	H2593_042_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H2593	042	0	1	01	01	H2593_042_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H2610	005	0	1	01	01	H2610_005_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H2610	005	0	1	01	01	H2610_005_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	2	2	01	3						
H2610	005	0	1	01	01	H2610_005_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H2610	005	0	1	01	01	H2610_005_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	4	2	10	1						
H2610	005	0	1	01	01	H2610_005_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H2610	005	0	1	01	01	H2610_005_0	7	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H2610	006	0	1	01	01	H2610_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H2610	006	0	1	01	01	H2610_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	2	2	01	3						
H2610	006	0	1	01	01	H2610_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H2610	006	0	1	01	01	H2610_006_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	4	2	10	1						
H2610	006	0	1	01	01	H2610_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H2610	006	0	1	01	01	H2610_006_0	7	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H2610	011	0	1	01	01	H2610_011_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H2610	011	0	1	01	01	H2610_011_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	2	2	01	3						
H2610	011	0	1	01	01	H2610_011_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H2610	011	0	1	01	01	H2610_011_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	4	2	10	1						
H2610	011	0	1	01	01	H2610_011_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H2610	011	0	1	01	01	H2610_011_0	7	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H2610	015	0	1	01	01	H2610_015_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H2610	015	0	1	01	01	H2610_015_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	2	2	01	3						
H2610	015	0	1	01	01	H2610_015_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H2610	015	0	1	01	01	H2610_015_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	4	2	10	1						
H2610	015	0	1	01	01	H2610_015_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H2610	015	0	1	01	01	H2610_015_0	7	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H2610	016	0	1	01	01	H2610_016_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H2610	016	0	1	01	01	H2610_016_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	2	2	01	3						
H2610	016	0	1	01	01	H2610_016_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H2610	016	0	1	01	01	H2610_016_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	4	2	10	1						
H2610	016	0	1	01	01	H2610_016_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H2610	016	0	1	01	01	H2610_016_0	7	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H2624	001	0	1	01	01	H2624_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2624	001	0	1	01	01	H2624_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2624	001	0	1	01	01	H2624_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2624	001	0	1	01	01	H2624_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2624	001	0	1	01	01	H2624_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2624	001	0	1	01	01	H2624_001_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2663	002	0	1	01	01	H2663_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2663	002	0	1	01	01	H2663_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2663	002	0	1	01	01	H2663_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	002	0	1	01	01	H2663_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	002	0	1	01	01	H2663_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	005	0	1	01	01	H2663_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	005	0	1	01	01	H2663_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	005	0	1	01	01	H2663_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	005	0	1	01	01	H2663_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	005	0	1	01	01	H2663_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	006	0	1	02	01	H2663_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	006	0	1	02	01	H2663_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	006	0	1	02	01	H2663_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	006	0	1	02	01	H2663_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	006	0	1	02	01	H2663_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	015	0	1	02	01	H2663_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H2663	015	0	1	02	01	H2663_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2663	015	0	1	02	01	H2663_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	015	0	1	02	01	H2663_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	015	0	1	02	01	H2663_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	017	0	1	01	01	H2663_017_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	017	0	1	01	01	H2663_017_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	017	0	1	01	01	H2663_017_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	017	0	1	01	01	H2663_017_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	017	0	1	01	01	H2663_017_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	021	0	1	01	01	H2663_021_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	021	0	1	01	01	H2663_021_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	021	0	1	01	01	H2663_021_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	021	0	1	01	01	H2663_021_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	021	0	1	01	01	H2663_021_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	023	0	1	02	01	H2663_023_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	023	0	1	02	01	H2663_023_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	023	0	1	02	01	H2663_023_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	023	0	1	02	01	H2663_023_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	023	0	1	02	01	H2663_023_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	026	0	1	01	01	H2663_026_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	026	0	1	01	01	H2663_026_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	026	0	1	01	01	H2663_026_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	026	0	1	01	01	H2663_026_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	026	0	1	01	01	H2663_026_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	028	0	1	01	01	H2663_028_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	028	0	1	01	01	H2663_028_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	028	0	1	01	01	H2663_028_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	028	0	1	01	01	H2663_028_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	028	0	1	01	01	H2663_028_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	029	0	1	01	01	H2663_029_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	029	0	1	01	01	H2663_029_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	029	0	1	01	01	H2663_029_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	029	0	1	01	01	H2663_029_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	029	0	1	01	01	H2663_029_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	032	0	1	01	01	H2663_032_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	032	0	1	01	01	H2663_032_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	032	0	1	01	01	H2663_032_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	032	0	1	01	01	H2663_032_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	032	0	1	01	01	H2663_032_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	034	0	1	01	01	H2663_034_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	034	0	1	01	01	H2663_034_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	034	0	1	01	01	H2663_034_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	034	0	1	01	01	H2663_034_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	034	0	1	01	01	H2663_034_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	035	0	1	01	01	H2663_035_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	035	0	1	01	01	H2663_035_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	035	0	1	01	01	H2663_035_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	035	0	1	01	01	H2663_035_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	035	0	1	01	01	H2663_035_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2663	036	0	1	01	01	H2663_036_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2663	036	0	1	01	01	H2663_036_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2663	036	0	1	01	01	H2663_036_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2663	036	0	1	01	01	H2663_036_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2663	036	0	1	01	01	H2663_036_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2678	001	0	1	01	01	H2678_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	3						
H2678	001	0	1	01	01	H2678_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2678	001	0	1	01	01	H2678_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2678	001	0	1	01	01	H2678_001_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2678	001	0	1	01	01	H2678_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2678	001	0	1	01	01	H2678_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H2678	002	0	1	01	01	H2678_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2678	002	0	1	01	01	H2678_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H2678	002	0	1	01	01	H2678_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2678	002	0	1	01	01	H2678_002_0	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2678	002	0	1	01	01	H2678_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2678	003	0	1	01	01	H2678_003_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2678	003	0	1	01	01	H2678_003_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H2678	003	0	1	01	01	H2678_003_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2678	003	0	1	01	01	H2678_003_0	3	Non-Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2678	003	0	1	01	01	H2678_003_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2678	004	0	1	01	01	H2678_004_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2678	004	0	1	01	01	H2678_004_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H2678	004	0	1	01	01	H2678_004_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2678	004	0	1	01	01	H2678_004_0	3	Non-Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2678	004	0	1	01	01	H2678_004_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H2697	001	0	1	01	01	H2697_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2697	001	0	1	01	01	H2697_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H2697	001	0	1	01	01	H2697_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2697	001	0	1	01	01	H2697_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2697	001	0	1	01	01	H2697_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2697	002	0	1	01	01	H2697_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2697	002	0	1	01	01	H2697_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H2697	002	0	1	01	01	H2697_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2697	002	0	1	01	01	H2697_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2697	002	0	1	01	01	H2697_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2697	003	0	1	01	01	H2697_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2697	003	0	1	01	01	H2697_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H2697	003	0	1	01	01	H2697_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2697	003	0	1	01	01	H2697_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2697	003	0	1	01	01	H2697_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2722	001	0	1	02	01	H2722_001_0	7	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2722	001	0	1	02	01	H2722_001_0	7	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H2722	001	0	1	02	01	H2722_001_0	7	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2722	001	0	1	02	01	H2722_001_0	7	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2722	001	0	1	02	01	H2722_001_0	7	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H2722	002	0	1	02	01	H2722_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2722	002	0	1	02	01	H2722_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H2722	002	0	1	02	01	H2722_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2722	002	0	1	02	01	H2722_002_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2722	002	0	1	02	01	H2722_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H2722	003	0	1	02	01	H2722_003_0	6	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2722	003	0	1	02	01	H2722_003_0	6	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H2722	003	0	1	02	01	H2722_003_0	6	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2722	003	0	1	02	01	H2722_003_0	6	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2722	003	0	1	02	01	H2722_003_0	6	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H2722	004	0	1	02	01	H2722_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H2722	004	0	1	02	01	H2722_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H2722	004	0	1	02	01	H2722_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H2722	004	0	1	02	01	H2722_004_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H2722	004	0	1	02	01	H2722_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H2765	002	0	1	01	01	H2765_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H2765	002	0	1	01	01	H2765_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H2765	002	0	1	01	01	H2765_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H2765	002	0	1	01	01	H2765_002_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H2765	002	0	1	01	01	H2765_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H2765	002	0	1	01	01	H2765_002_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H2765	003	0	1	02	01	H2765_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H2765	003	0	1	02	01	H2765_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H2765	003	0	1	02	01	H2765_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H2765	003	0	1	02	01	H2765_003_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H2765	003	0	1	02	01	H2765_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H2765	003	0	1	02	01	H2765_003_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H2765	004	0	1	02	01	H2765_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H2765	004	0	1	02	01	H2765_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H2765	004	0	1	02	01	H2765_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H2765	004	0	1	02	01	H2765_004_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H2765	004	0	1	02	01	H2765_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H2765	004	0	1	02	01	H2765_004_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H2775	100	0	1	04	01	H2775_100_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2775	100	0	1	04	01	H2775_100_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2775	100	0	1	04	01	H2775_100_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2775	100	0	1	04	01	H2775_100_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2775	100	0	1	04	01	H2775_100_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2775	105	0	1	04	01	H2775_105_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2775	105	0	1	04	01	H2775_105_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2775	105	0	1	04	01	H2775_105_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2775	105	0	1	04	01	H2775_105_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2775	105	0	1	04	01	H2775_105_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2775	106	0	1	04	01	H2775_106_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2775	106	0	1	04	01	H2775_106_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2775	106	0	1	04	01	H2775_106_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2775	106	0	1	04	01	H2775_106_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2775	106	0	1	04	01	H2775_106_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2775	109	0	1	04	01	H2775_109_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2775	109	0	1	04	01	H2775_109_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2775	109	0	1	04	01	H2775_109_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2775	109	0	1	04	01	H2775_109_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2775	109	0	1	04	01	H2775_109_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2775	111	0	1	04	01	H2775_111_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2775	111	0	1	04	01	H2775_111_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2775	111	0	1	04	01	H2775_111_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2775	111	0	1	04	01	H2775_111_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2775	111	0	1	04	01	H2775_111_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2775	112	0	1	04	01	H2775_112_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2775	112	0	1	04	01	H2775_112_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2775	112	0	1	04	01	H2775_112_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2775	112	0	1	04	01	H2775_112_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2775	112	0	1	04	01	H2775_112_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2775	113	0	1	04	01	H2775_113_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2775	113	0	1	04	01	H2775_113_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2775	113	0	1	04	01	H2775_113_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2775	113	0	1	04	01	H2775_113_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2775	113	0	1	04	01	H2775_113_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2782	002	0	1	01	01	H2782_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2782	002	0	1	01	01	H2782_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2782	002	0	1	01	01	H2782_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2782	002	0	1	01	01	H2782_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2782	002	0	1	01	01	H2782_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2782	003	0	1	01	01	H2782_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2782	003	0	1	01	01	H2782_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2782	003	0	1	01	01	H2782_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2782	003	0	1	01	01	H2782_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2782	003	0	1	01	01	H2782_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2793	003	0	1	01	01	H2793_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2793	003	0	1	01	01	H2793_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H2793	003	0	1	01	01	H2793_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2793	003	0	1	01	01	H2793_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2793	003	0	1	01	01	H2793_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2793	004	0	1	01	01	H2793_004_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2793	004	0	1	01	01	H2793_004_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H2793	004	0	1	01	01	H2793_004_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2793	004	0	1	01	01	H2793_004_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2793	004	0	1	01	01	H2793_004_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2793	005	0	1	01	01	H2793_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H2793	005	0	1	01	01	H2793_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H2793	005	0	1	01	01	H2793_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2793	005	0	1	01	01	H2793_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2793	005	0	1	01	01	H2793_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2793	005	0	1	01	01	H2793_005_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H2793	007	0	1	01	01	H2793_007_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2793	007	0	1	01	01	H2793_007_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H2793	007	0	1	01	01	H2793_007_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2793	007	0	1	01	01	H2793_007_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2793	007	0	1	01	01	H2793_007_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	001	0	1	02	01	H2802_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	001	0	1	02	01	H2802_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	001	0	1	02	01	H2802_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	001	0	1	02	01	H2802_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	001	0	1	02	01	H2802_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	007	0	1	02	01	H2802_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	007	0	1	02	01	H2802_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	007	0	1	02	01	H2802_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	007	0	1	02	01	H2802_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	007	0	1	02	01	H2802_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	008	0	1	02	01	H2802_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	008	0	1	02	01	H2802_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	008	0	1	02	01	H2802_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	008	0	1	02	01	H2802_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	008	0	1	02	01	H2802_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	010	0	1	02	01	H2802_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	010	0	1	02	01	H2802_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	010	0	1	02	01	H2802_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	010	0	1	02	01	H2802_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	010	0	1	02	01	H2802_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	012	0	1	02	01	H2802_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	012	0	1	02	01	H2802_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	012	0	1	02	01	H2802_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	012	0	1	02	01	H2802_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	012	0	1	02	01	H2802_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	015	0	1	02	01	H2802_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	015	0	1	02	01	H2802_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	015	0	1	02	01	H2802_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	015	0	1	02	01	H2802_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	015	0	1	02	01	H2802_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	016	0	1	02	01	H2802_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	016	0	1	02	01	H2802_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	016	0	1	02	01	H2802_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	016	0	1	02	01	H2802_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	016	0	1	02	01	H2802_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	018	0	1	02	01	H2802_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	018	0	1	02	01	H2802_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	018	0	1	02	01	H2802_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	018	0	1	02	01	H2802_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	018	0	1	02	01	H2802_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	020	0	1	02	01	H2802_020_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	020	0	1	02	01	H2802_020_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	020	0	1	02	01	H2802_020_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	020	0	1	02	01	H2802_020_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	020	0	1	02	01	H2802_020_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	024	0	1	01	01	H2802_024_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	024	0	1	01	01	H2802_024_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	024	0	1	01	01	H2802_024_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	024	0	1	01	01	H2802_024_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	024	0	1	01	01	H2802_024_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	025	0	1	01	01	H2802_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	025	0	1	01	01	H2802_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	025	0	1	01	01	H2802_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	025	0	1	01	01	H2802_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	025	0	1	01	01	H2802_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	026	0	1	01	01	H2802_026_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	026	0	1	01	01	H2802_026_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	026	0	1	01	01	H2802_026_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	026	0	1	01	01	H2802_026_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	026	0	1	01	01	H2802_026_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	028	0	1	02	01	H2802_028_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	028	0	1	02	01	H2802_028_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	028	0	1	02	01	H2802_028_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	028	0	1	02	01	H2802_028_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	028	0	1	02	01	H2802_028_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	029	0	1	02	01	H2802_029_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	029	0	1	02	01	H2802_029_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	029	0	1	02	01	H2802_029_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	029	0	1	02	01	H2802_029_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	029	0	1	02	01	H2802_029_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	030	0	1	02	01	H2802_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	030	0	1	02	01	H2802_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	030	0	1	02	01	H2802_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	030	0	1	02	01	H2802_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	030	0	1	02	01	H2802_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	031	0	1	02	01	H2802_031_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	031	0	1	02	01	H2802_031_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	031	0	1	02	01	H2802_031_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	031	0	1	02	01	H2802_031_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	031	0	1	02	01	H2802_031_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	032	0	1	02	01	H2802_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	032	0	1	02	01	H2802_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	032	0	1	02	01	H2802_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	032	0	1	02	01	H2802_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	032	0	1	02	01	H2802_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	033	0	1	02	01	H2802_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	033	0	1	02	01	H2802_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	033	0	1	02	01	H2802_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	033	0	1	02	01	H2802_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	033	0	1	02	01	H2802_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	034	0	1	02	01	H2802_034_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	034	0	1	02	01	H2802_034_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	034	0	1	02	01	H2802_034_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	034	0	1	02	01	H2802_034_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	034	0	1	02	01	H2802_034_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	035	0	1	02	01	H2802_035_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	035	0	1	02	01	H2802_035_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	035	0	1	02	01	H2802_035_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	035	0	1	02	01	H2802_035_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	035	0	1	02	01	H2802_035_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	041	0	1	01	01	H2802_041_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	041	0	1	01	01	H2802_041_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	041	0	1	01	01	H2802_041_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	041	0	1	01	01	H2802_041_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	041	0	1	01	01	H2802_041_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	048	0	1	01	01	H2802_048_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	048	0	1	01	01	H2802_048_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	048	0	1	01	01	H2802_048_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	048	0	1	01	01	H2802_048_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	048	0	1	01	01	H2802_048_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2802	049	0	1	02	01	H2802_049_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2802	049	0	1	02	01	H2802_049_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H2802	049	0	1	02	01	H2802_049_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2802	049	0	1	02	01	H2802_049_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2802	049	0	1	02	01	H2802_049_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2816	013	0	1	09	04	H2816_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2816	013	0	1	09	04	H2816_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2816	013	0	1	09	04	H2816_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2816	013	0	1	09	04	H2816_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2816	013	0	1	09	04	H2816_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2816	019	0	1	09	04	H2816_019_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H2816	019	0	1	09	04	H2816_019_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2816	019	0	1	09	04	H2816_019_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2816	019	0	1	09	04	H2816_019_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2816	019	0	1	09	04	H2816_019_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2825	001	0	1	01	01	H2825_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2825	001	0	1	01	01	H2825_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H2825	001	0	1	01	01	H2825_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2825	001	0	1	01	01	H2825_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2825	001	0	1	01	01	H2825_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2825	002	0	1	01	01	H2825_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2825	002	0	1	01	01	H2825_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H2825	002	0	1	01	01	H2825_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2825	002	0	1	01	01	H2825_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2825	002	0	1	01	01	H2825_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2829	001	0	1	01	01	H2829_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2829	001	0	1	01	01	H2829_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2829	001	0	1	01	01	H2829_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2829	001	0	1	01	01	H2829_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2829	001	0	1	01	01	H2829_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2836	005	0	1	04	01	H2836_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2836	005	0	1	04	01	H2836_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2836	005	0	1	04	01	H2836_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2836	005	0	1	04	01	H2836_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2836	005	0	1	04	01	H2836_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2836	005	0	1	04	01	H2836_005_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H2853	001	0	1	01	01	H2853_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2853	001	0	1	01	01	H2853_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2853	001	0	1	01	01	H2853_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2853	001	0	1	01	01	H2853_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2853	001	0	1	01	01	H2853_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2853	001	0	1	01	01	H2853_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2853	002	0	1	01	01	H2853_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2853	002	0	1	01	01	H2853_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2853	002	0	1	01	01	H2853_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2853	002	0	1	01	01	H2853_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2853	002	0	1	01	01	H2853_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2853	002	0	1	01	01	H2853_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2879	001	0	1	01	01	H2879_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2879	001	0	1	01	01	H2879_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2879	001	0	1	01	01	H2879_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2879	001	0	1	01	01	H2879_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2879	001	0	1	01	01	H2879_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2915	001	0	1	01	01	H2915_001_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2915	001	0	1	01	01	H2915_001_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2915	001	0	1	01	01	H2915_001_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2915	001	0	1	01	01	H2915_001_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2915	001	0	1	01	01	H2915_001_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2915	002	0	1	01	01	H2915_002_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2915	002	0	1	01	01	H2915_002_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2915	002	0	1	01	01	H2915_002_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2915	002	0	1	01	01	H2915_002_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2915	002	0	1	01	01	H2915_002_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2915	003	0	1	01	01	H2915_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2915	003	0	1	01	01	H2915_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2915	003	0	1	01	01	H2915_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2915	003	0	1	01	01	H2915_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2915	003	0	1	01	01	H2915_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2915	003	0	1	01	01	H2915_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2915	007	0	1	01	01	H2915_007_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2915	007	0	1	01	01	H2915_007_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2915	007	0	1	01	01	H2915_007_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2915	007	0	1	01	01	H2915_007_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2915	007	0	1	01	01	H2915_007_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2915	011	0	1	01	01	H2915_011_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2915	011	0	1	01	01	H2915_011_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H2915	011	0	1	01	01	H2915_011_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2915	011	0	1	01	01	H2915_011_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2915	011	0	1	01	01	H2915_011_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2915	012	0	1	01	01	H2915_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2915	012	0	1	01	01	H2915_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2915	012	0	1	01	01	H2915_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2915	012	0	1	01	01	H2915_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2915	012	0	1	01	01	H2915_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2915	012	0	1	01	01	H2915_012_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2915	014	0	1	01	01	H2915_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2915	014	0	1	01	01	H2915_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2915	014	0	1	01	01	H2915_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2915	014	0	1	01	01	H2915_014_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2915	014	0	1	01	01	H2915_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2915	014	0	1	01	01	H2915_014_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2915	015	2	1	01	01	H2915_015_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2915	015	2	1	01	01	H2915_015_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2915	015	2	1	01	01	H2915_015_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2915	015	2	1	01	01	H2915_015_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2915	015	2	1	01	01	H2915_015_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2915	015	2	1	01	01	H2915_015_2	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2915	015	3	1	01	01	H2915_015_3	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2915	015	3	1	01	01	H2915_015_3	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H2915	015	3	1	01	01	H2915_015_3	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H2915	015	3	1	01	01	H2915_015_3	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2915	015	3	1	01	01	H2915_015_3	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2915	015	3	1	01	01	H2915_015_3	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H2944	013	0	1	09	04	H2944_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2944	013	0	1	09	04	H2944_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2944	013	0	1	09	04	H2944_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2944	013	0	1	09	04	H2944_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2944	013	0	1	09	04	H2944_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2944	114	0	1	09	04	H2944_114_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H2944	114	0	1	09	04	H2944_114_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2944	114	0	1	09	04	H2944_114_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H2944	114	0	1	09	04	H2944_114_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2944	114	0	1	09	04	H2944_114_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H2960	012	0	1	01	01	H2960_012_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2960	012	0	1	01	01	H2960_012_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2960	012	0	1	01	01	H2960_012_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2960	012	0	1	01	01	H2960_012_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2960	012	0	1	01	01	H2960_012_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2960	012	0	1	01	01	H2960_012_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2960	018	0	1	01	01	H2960_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2960	018	0	1	01	01	H2960_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2960	018	0	1	01	01	H2960_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2960	018	0	1	01	01	H2960_018_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2960	018	0	1	01	01	H2960_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2960	018	0	1	01	01	H2960_018_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2960	019	0	1	01	01	H2960_019_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2960	019	0	1	01	01	H2960_019_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2960	019	0	1	01	01	H2960_019_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2960	019	0	1	01	01	H2960_019_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2960	019	0	1	01	01	H2960_019_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2960	019	0	1	01	01	H2960_019_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2960	021	0	1	01	01	H2960_021_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2960	021	0	1	01	01	H2960_021_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2960	021	0	1	01	01	H2960_021_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2960	021	0	1	01	01	H2960_021_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2960	021	0	1	01	01	H2960_021_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2960	021	0	1	01	01	H2960_021_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2960	022	0	1	01	01	H2960_022_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2960	022	0	1	01	01	H2960_022_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2960	022	0	1	01	01	H2960_022_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2960	022	0	1	01	01	H2960_022_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2960	022	0	1	01	01	H2960_022_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2960	022	0	1	01	01	H2960_022_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2960	023	0	1	01	01	H2960_023_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2960	023	0	1	01	01	H2960_023_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2960	023	0	1	01	01	H2960_023_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2960	023	0	1	01	01	H2960_023_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2960	023	0	1	01	01	H2960_023_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2960	023	0	1	01	01	H2960_023_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2962	001	0	1	01	01	H2962_001_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	001	0	1	01	01	H2962_001_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	001	0	1	01	01	H2962_001_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	001	0	1	01	01	H2962_001_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	011	0	1	01	01	H2962_011_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	011	0	1	01	01	H2962_011_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	011	0	1	01	01	H2962_011_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	011	0	1	01	01	H2962_011_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	012	0	1	01	01	H2962_012_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	012	0	1	01	01	H2962_012_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	012	0	1	01	01	H2962_012_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	012	0	1	01	01	H2962_012_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	013	3	1	01	01	H2962_013_3	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	013	3	1	01	01	H2962_013_3	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	013	3	1	01	01	H2962_013_3	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	013	3	1	01	01	H2962_013_3	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	013	4	1	01	01	H2962_013_4	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	013	4	1	01	01	H2962_013_4	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	013	4	1	01	01	H2962_013_4	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	013	4	1	01	01	H2962_013_4	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	014	1	1	01	01	H2962_014_1	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	014	1	1	01	01	H2962_014_1	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	014	1	1	01	01	H2962_014_1	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	014	1	1	01	01	H2962_014_1	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	014	2	1	01	01	H2962_014_2	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	014	2	1	01	01	H2962_014_2	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	014	2	1	01	01	H2962_014_2	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	014	2	1	01	01	H2962_014_2	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	016	0	1	01	01	H2962_016_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	016	0	1	01	01	H2962_016_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	016	0	1	01	01	H2962_016_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	016	0	1	01	01	H2962_016_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	019	1	1	01	01	H2962_019_1	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	019	1	1	01	01	H2962_019_1	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	019	1	1	01	01	H2962_019_1	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	019	1	1	01	01	H2962_019_1	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	019	1	1	01	01	H2962_019_1	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	019	2	1	01	01	H2962_019_2	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	019	2	1	01	01	H2962_019_2	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	019	2	1	01	01	H2962_019_2	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	019	2	1	01	01	H2962_019_2	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	019	2	1	01	01	H2962_019_2	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	021	0	1	01	01	H2962_021_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	021	0	1	01	01	H2962_021_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	021	0	1	01	01	H2962_021_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	021	0	1	01	01	H2962_021_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	021	0	1	01	01	H2962_021_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	022	0	1	01	01	H2962_022_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	022	0	1	01	01	H2962_022_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	022	0	1	01	01	H2962_022_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	022	0	1	01	01	H2962_022_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	022	0	1	01	01	H2962_022_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	023	0	1	01	01	H2962_023_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	023	0	1	01	01	H2962_023_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	023	0	1	01	01	H2962_023_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	023	0	1	01	01	H2962_023_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	023	0	1	01	01	H2962_023_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	024	0	1	01	01	H2962_024_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	024	0	1	01	01	H2962_024_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	024	0	1	01	01	H2962_024_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	024	0	1	01	01	H2962_024_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	024	0	1	01	01	H2962_024_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	025	0	1	01	01	H2962_025_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	025	0	1	01	01	H2962_025_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	025	0	1	01	01	H2962_025_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	025	0	1	01	01	H2962_025_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	025	0	1	01	01	H2962_025_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	026	0	1	01	01	H2962_026_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	026	0	1	01	01	H2962_026_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	026	0	1	01	01	H2962_026_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	026	0	1	01	01	H2962_026_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	026	0	1	01	01	H2962_026_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	027	0	1	01	01	H2962_027_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	027	0	1	01	01	H2962_027_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	027	0	1	01	01	H2962_027_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	027	0	1	01	01	H2962_027_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	027	0	1	01	01	H2962_027_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	028	0	1	01	01	H2962_028_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	028	0	1	01	01	H2962_028_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	028	0	1	01	01	H2962_028_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	028	0	1	01	01	H2962_028_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	029	0	1	01	01	H2962_029_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	029	0	1	01	01	H2962_029_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	029	0	1	01	01	H2962_029_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	029	0	1	01	01	H2962_029_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	029	0	1	01	01	H2962_029_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	030	0	1	01	01	H2962_030_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	030	0	1	01	01	H2962_030_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	030	0	1	01	01	H2962_030_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	030	0	1	01	01	H2962_030_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	030	0	1	01	01	H2962_030_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	031	0	1	01	01	H2962_031_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	031	0	1	01	01	H2962_031_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	031	0	1	01	01	H2962_031_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	031	0	1	01	01	H2962_031_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	032	0	1	01	01	H2962_032_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H2962	032	0	1	01	01	H2962_032_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H2962	032	0	1	01	01	H2962_032_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H2962	032	0	1	01	01	H2962_032_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H2962	033	0	1	01	01	H2962_033_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	033	0	1	01	01	H2962_033_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	033	0	1	01	01	H2962_033_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	033	0	1	01	01	H2962_033_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	033	0	1	01	01	H2962_033_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2962	034	0	1	01	01	H2962_034_0	9	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H2962	034	0	1	01	01	H2962_034_0	9	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H2962	034	0	1	01	01	H2962_034_0	9	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H2962	034	0	1	01	01	H2962_034_0	9	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H2962	034	0	1	01	01	H2962_034_0	9	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H2986	001	0	1	01	01	H2986_001_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2986	001	0	1	01	01	H2986_001_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2986	001	0	1	01	01	H2986_001_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2986	001	0	1	01	01	H2986_001_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2986	001	0	1	01	01	H2986_001_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2986	001	0	1	01	01	H2986_001_0	11	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2986	002	0	1	01	01	H2986_002_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2986	002	0	1	01	01	H2986_002_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2986	002	0	1	01	01	H2986_002_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2986	002	0	1	01	01	H2986_002_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2986	002	0	1	01	01	H2986_002_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2986	002	0	1	01	01	H2986_002_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2986	004	0	1	01	01	H2986_004_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2986	004	0	1	01	01	H2986_004_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2986	004	0	1	01	01	H2986_004_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2986	004	0	1	01	01	H2986_004_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2986	004	0	1	01	01	H2986_004_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2986	004	0	1	01	01	H2986_004_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2986	006	0	1	01	01	H2986_006_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2986	006	0	1	01	01	H2986_006_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2986	006	0	1	01	01	H2986_006_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2986	006	0	1	01	01	H2986_006_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2986	006	0	1	01	01	H2986_006_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2986	006	0	1	01	01	H2986_006_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H2986	007	0	1	01	01	H2986_007_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H2986	007	0	1	01	01	H2986_007_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H2986	007	0	1	01	01	H2986_007_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H2986	007	0	1	01	01	H2986_007_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H2986	007	0	1	01	01	H2986_007_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H2986	007	0	1	01	01	H2986_007_0	11	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H3047	001	0	1	04	01	H3047_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H3047	001	0	1	04	01	H3047_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3047	001	0	1	04	01	H3047_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3047	001	0	1	04	01	H3047_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3047	001	0	1	04	01	H3047_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3047	002	0	1	04	01	H3047_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H3047	002	0	1	04	01	H3047_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3047	002	0	1	04	01	H3047_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3047	002	0	1	04	01	H3047_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3047	002	0	1	04	01	H3047_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3071	002	0	1	01	01	H3071_002_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3071	002	0	1	01	01	H3071_002_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3071	002	0	1	01	01	H3071_002_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3071	002	0	1	01	01	H3071_002_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3071	002	0	1	01	01	H3071_002_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3071	003	0	1	02	01	H3071_003_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3071	003	0	1	02	01	H3071_003_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3071	003	0	1	02	01	H3071_003_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3071	003	0	1	02	01	H3071_003_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3071	003	0	1	02	01	H3071_003_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3113	008	0	1	02	01	H3113_008_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3113	008	0	1	02	01	H3113_008_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3113	008	0	1	02	01	H3113_008_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3113	008	0	1	02	01	H3113_008_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3113	008	0	1	02	01	H3113_008_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3132	001	0	1	01	01	H3132_001_0	4	Generic	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H3132	001	0	1	01	01	H3132_001_0	4	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H3132	001	0	1	01	01	H3132_001_0	4	Non-Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H3132	001	0	1	01	01	H3132_001_0	4	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H3132	001	0	1	01	01	H3132_001_0	4	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	01	1						
H3146	001	0	1	01	01	H3146_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	001	0	1	01	01	H3146_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	001	0	1	01	01	H3146_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	001	0	1	01	01	H3146_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	001	0	1	01	01	H3146_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	002	0	1	01	01	H3146_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	002	0	1	01	01	H3146_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	002	0	1	01	01	H3146_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	002	0	1	01	01	H3146_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	002	0	1	01	01	H3146_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	003	0	1	01	01	H3146_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	003	0	1	01	01	H3146_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	003	0	1	01	01	H3146_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	003	0	1	01	01	H3146_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	003	0	1	01	01	H3146_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	004	0	1	01	01	H3146_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	004	0	1	01	01	H3146_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	004	0	1	01	01	H3146_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	004	0	1	01	01	H3146_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	004	0	1	01	01	H3146_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	005	0	1	01	01	H3146_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	005	0	1	01	01	H3146_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	005	0	1	01	01	H3146_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	005	0	1	01	01	H3146_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	005	0	1	01	01	H3146_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	006	0	1	01	01	H3146_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	006	0	1	01	01	H3146_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	006	0	1	01	01	H3146_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	006	0	1	01	01	H3146_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	006	0	1	01	01	H3146_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	007	0	1	01	01	H3146_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	007	0	1	01	01	H3146_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	007	0	1	01	01	H3146_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	007	0	1	01	01	H3146_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	007	0	1	01	01	H3146_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	008	0	1	01	01	H3146_008_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	008	0	1	01	01	H3146_008_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	008	0	1	01	01	H3146_008_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	008	0	1	01	01	H3146_008_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	008	0	1	01	01	H3146_008_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	009	0	1	01	01	H3146_009_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	009	0	1	01	01	H3146_009_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	009	0	1	01	01	H3146_009_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	009	0	1	01	01	H3146_009_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	009	0	1	01	01	H3146_009_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	010	0	1	01	01	H3146_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	010	0	1	01	01	H3146_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	010	0	1	01	01	H3146_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	010	0	1	01	01	H3146_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	010	0	1	01	01	H3146_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	011	0	1	01	01	H3146_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	011	0	1	01	01	H3146_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	011	0	1	01	01	H3146_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	011	0	1	01	01	H3146_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	011	0	1	01	01	H3146_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	012	0	1	01	01	H3146_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	012	0	1	01	01	H3146_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	012	0	1	01	01	H3146_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	012	0	1	01	01	H3146_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	012	0	1	01	01	H3146_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3146	013	0	1	01	01	H3146_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3146	013	0	1	01	01	H3146_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3146	013	0	1	01	01	H3146_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3146	013	0	1	01	01	H3146_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3146	013	0	1	01	01	H3146_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3152	022	0	1	01	01	H3152_022_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3152	022	0	1	01	01	H3152_022_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3152	022	0	1	01	01	H3152_022_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3152	022	0	1	01	01	H3152_022_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3152	022	0	1	01	01	H3152_022_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3152	048	0	1	01	01	H3152_048_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3152	048	0	1	01	01	H3152_048_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3152	048	0	1	01	01	H3152_048_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3152	048	0	1	01	01	H3152_048_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3152	048	0	1	01	01	H3152_048_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3152	080	0	1	01	01	H3152_080_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3152	080	0	1	01	01	H3152_080_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3152	080	0	1	01	01	H3152_080_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3152	080	0	1	01	01	H3152_080_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3152	080	0	1	01	01	H3152_080_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3152	082	0	1	01	01	H3152_082_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3152	082	0	1	01	01	H3152_082_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3152	082	0	1	01	01	H3152_082_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3152	082	0	1	01	01	H3152_082_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3152	082	0	1	01	01	H3152_082_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3152	084	0	1	01	01	H3152_084_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3152	084	0	1	01	01	H3152_084_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3152	084	0	1	01	01	H3152_084_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3152	084	0	1	01	01	H3152_084_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3152	084	0	1	01	01	H3152_084_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3152	088	0	1	01	01	H3152_088_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3152	088	0	1	01	01	H3152_088_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3152	088	0	1	01	01	H3152_088_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3152	088	0	1	01	01	H3152_088_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3152	088	0	1	01	01	H3152_088_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3152	092	0	1	01	01	H3152_092_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3152	092	0	1	01	01	H3152_092_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3152	092	0	1	01	01	H3152_092_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3152	092	0	1	01	01	H3152_092_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3152	092	0	1	01	01	H3152_092_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3154	004	0	1	01	01	H3154_004_0	10	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3154	004	0	1	01	01	H3154_004_0	10	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3154	004	0	1	01	01	H3154_004_0	10	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3154	004	0	1	01	01	H3154_004_0	10	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3154	004	0	1	01	01	H3154_004_0	10	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3154	022	0	1	01	01	H3154_022_0	8	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3154	022	0	1	01	01	H3154_022_0	8	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3154	022	0	1	01	01	H3154_022_0	8	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3154	022	0	1	01	01	H3154_022_0	8	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3154	022	0	1	01	01	H3154_022_0	8	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3154	029	0	1	01	01	H3154_029_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3154	029	0	1	01	01	H3154_029_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3154	029	0	1	01	01	H3154_029_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3154	029	0	1	01	01	H3154_029_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3154	029	0	1	01	01	H3154_029_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3154	030	0	1	01	01	H3154_030_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3154	030	0	1	01	01	H3154_030_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3154	030	0	1	01	01	H3154_030_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3154	030	0	1	01	01	H3154_030_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3154	030	0	1	01	01	H3154_030_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3154	031	0	1	01	01	H3154_031_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3154	031	0	1	01	01	H3154_031_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3154	031	0	1	01	01	H3154_031_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3154	031	0	1	01	01	H3154_031_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3154	031	0	1	01	01	H3154_031_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3154	032	0	1	01	01	H3154_032_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3154	032	0	1	01	01	H3154_032_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3154	032	0	1	01	01	H3154_032_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3154	032	0	1	01	01	H3154_032_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3154	032	0	1	01	01	H3154_032_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3154	033	0	1	02	01	H3154_033_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3154	033	0	1	02	01	H3154_033_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3154	033	0	1	02	01	H3154_033_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3154	033	0	1	02	01	H3154_033_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3154	033	0	1	02	01	H3154_033_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3170	002	0	1	02	01	H3170_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3170	002	0	1	02	01	H3170_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3170	002	0	1	02	01	H3170_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3170	002	0	1	02	01	H3170_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3170	002	0	1	02	01	H3170_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3170	003	1	1	01	01	H3170_003_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3170	003	1	1	01	01	H3170_003_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3170	003	1	1	01	01	H3170_003_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3170	003	1	1	01	01	H3170_003_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3170	003	1	1	01	01	H3170_003_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3170	003	2	1	01	01	H3170_003_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3170	003	2	1	01	01	H3170_003_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3170	003	2	1	01	01	H3170_003_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3170	003	2	1	01	01	H3170_003_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3170	003	2	1	01	01	H3170_003_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3192	001	0	1	01	01	H3192_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3192	001	0	1	01	01	H3192_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3192	001	0	1	01	01	H3192_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3192	001	0	1	01	01	H3192_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3192	001	0	1	01	01	H3192_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3192	002	0	1	01	01	H3192_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3192	002	0	1	01	01	H3192_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3192	002	0	1	01	01	H3192_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3192	002	0	1	01	01	H3192_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3192	002	0	1	01	01	H3192_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3192	003	0	1	01	01	H3192_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3192	003	0	1	01	01	H3192_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3192	003	0	1	01	01	H3192_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3192	003	0	1	01	01	H3192_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3192	003	0	1	01	01	H3192_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3192	004	0	1	01	01	H3192_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3192	004	0	1	01	01	H3192_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3192	004	0	1	01	01	H3192_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3192	004	0	1	01	01	H3192_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3192	004	0	1	01	01	H3192_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3192	005	0	1	01	01	H3192_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3192	005	0	1	01	01	H3192_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3192	005	0	1	01	01	H3192_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3192	005	0	1	01	01	H3192_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3192	005	0	1	01	01	H3192_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3192	006	0	1	01	01	H3192_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3192	006	0	1	01	01	H3192_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3192	006	0	1	01	01	H3192_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3192	006	0	1	01	01	H3192_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3192	006	0	1	01	01	H3192_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3192	007	0	1	01	01	H3192_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3192	007	0	1	01	01	H3192_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3192	007	0	1	01	01	H3192_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3192	007	0	1	01	01	H3192_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3192	007	0	1	01	01	H3192_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3204	001	0	1	01	01	H3204_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3204	001	0	1	01	01	H3204_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3204	001	0	1	01	01	H3204_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3204	001	0	1	01	01	H3204_001_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3204	001	0	1	01	01	H3204_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3204	007	0	1	01	01	H3204_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3204	007	0	1	01	01	H3204_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3204	007	0	1	01	01	H3204_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3204	007	0	1	01	01	H3204_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3204	007	0	1	01	01	H3204_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3206	001	0	1	04	01	H3206_001_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3206	001	0	1	04	01	H3206_001_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3206	001	0	1	04	01	H3206_001_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3206	001	0	1	04	01	H3206_001_0	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3206	001	0	1	04	01	H3206_001_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3213	011	0	1	01	01	H3213_011_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3213	011	0	1	01	01	H3213_011_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3213	011	0	1	01	01	H3213_011_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3213	011	0	1	01	01	H3213_011_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3213	011	0	1	01	01	H3213_011_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3213	011	0	1	01	01	H3213_011_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3213	012	0	1	01	01	H3213_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3213	012	0	1	01	01	H3213_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3213	012	0	1	01	01	H3213_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3213	012	0	1	01	01	H3213_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3213	012	0	1	01	01	H3213_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3213	012	0	1	01	01	H3213_012_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3213	013	0	1	01	01	H3213_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3213	013	0	1	01	01	H3213_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3213	013	0	1	01	01	H3213_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3213	013	0	1	01	01	H3213_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3213	013	0	1	01	01	H3213_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3213	013	0	1	01	01	H3213_013_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3213	014	0	1	01	01	H3213_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3213	014	0	1	01	01	H3213_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3213	014	0	1	01	01	H3213_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3213	014	0	1	01	01	H3213_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3213	014	0	1	01	01	H3213_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3213	014	0	1	01	01	H3213_014_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3213	015	0	1	01	01	H3213_015_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3213	015	0	1	01	01	H3213_015_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3213	015	0	1	01	01	H3213_015_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3213	015	0	1	01	01	H3213_015_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3213	015	0	1	01	01	H3213_015_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3213	015	0	1	01	01	H3213_015_0	3	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3213	016	0	1	01	01	H3213_016_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3213	016	0	1	01	01	H3213_016_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3213	016	0	1	01	01	H3213_016_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3213	016	0	1	01	01	H3213_016_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3213	016	0	1	01	01	H3213_016_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3213	016	0	1	01	01	H3213_016_0	3	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3219	001	0	1	04	01	H3219_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3219	001	0	1	04	01	H3219_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3219	001	0	1	04	01	H3219_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3219	001	0	1	04	01	H3219_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3219	001	0	1	04	01	H3219_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3219	002	0	1	04	01	H3219_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3219	002	0	1	04	01	H3219_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3219	002	0	1	04	01	H3219_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3219	002	0	1	04	01	H3219_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3219	002	0	1	04	01	H3219_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3219	003	0	1	04	01	H3219_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3219	003	0	1	04	01	H3219_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3219	003	0	1	04	01	H3219_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3219	003	0	1	04	01	H3219_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3219	003	0	1	04	01	H3219_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3219	004	0	1	04	01	H3219_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3219	004	0	1	04	01	H3219_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3219	004	0	1	04	01	H3219_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3219	004	0	1	04	01	H3219_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3219	004	0	1	04	01	H3219_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3237	001	0	1	48	05	H3237_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H3237	001	0	1	48	05	H3237_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H3237	001	0	1	48	05	H3237_001_0	3	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H3237	002	0	1	48	05	H3237_002_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H3237	002	0	1	48	05	H3237_002_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H3237	002	0	1	48	05	H3237_002_0	3	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H3239	001	0	1	01	01	H3239_001_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3239	001	0	1	01	01	H3239_001_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3239	001	0	1	01	01	H3239_001_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3239	001	0	1	01	01	H3239_001_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3239	001	0	1	01	01	H3239_001_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3239	002	0	1	01	01	H3239_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3239	002	0	1	01	01	H3239_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3239	002	0	1	01	01	H3239_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3239	002	0	1	01	01	H3239_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3239	002	0	1	01	01	H3239_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3239	003	0	1	01	01	H3239_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3239	003	0	1	01	01	H3239_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3239	003	0	1	01	01	H3239_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3239	003	0	1	01	01	H3239_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3239	003	0	1	01	01	H3239_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3239	005	0	1	01	01	H3239_005_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3239	005	0	1	01	01	H3239_005_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3239	005	0	1	01	01	H3239_005_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3239	005	0	1	01	01	H3239_005_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3239	005	0	1	01	01	H3239_005_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3239	006	0	1	01	01	H3239_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3239	006	0	1	01	01	H3239_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3239	006	0	1	01	01	H3239_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3239	006	0	1	01	01	H3239_006_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3239	006	0	1	01	01	H3239_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3239	007	0	1	01	01	H3239_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3239	007	0	1	01	01	H3239_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3239	007	0	1	01	01	H3239_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3239	007	0	1	01	01	H3239_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3239	007	0	1	01	01	H3239_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3240	013	0	1	01	01	H3240_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3240	013	0	1	01	01	H3240_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3240	013	0	1	01	01	H3240_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3240	013	0	1	01	01	H3240_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3240	013	0	1	01	01	H3240_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3240	013	0	1	01	01	H3240_013_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3240	017	0	1	02	01	H3240_017_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3240	017	0	1	02	01	H3240_017_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3240	017	0	1	02	01	H3240_017_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3240	017	0	1	02	01	H3240_017_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3240	017	0	1	02	01	H3240_017_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3240	017	0	1	02	01	H3240_017_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3240	021	0	1	01	01	H3240_021_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3240	021	0	1	01	01	H3240_021_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3240	021	0	1	01	01	H3240_021_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3240	021	0	1	01	01	H3240_021_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3240	021	0	1	01	01	H3240_021_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3240	021	0	1	01	01	H3240_021_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3240	022	0	1	01	01	H3240_022_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3240	022	0	1	01	01	H3240_022_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3240	022	0	1	01	01	H3240_022_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3240	022	0	1	01	01	H3240_022_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3240	022	0	1	01	01	H3240_022_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3240	022	0	1	01	01	H3240_022_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3240	024	0	1	02	01	H3240_024_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3240	024	0	1	02	01	H3240_024_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3240	024	0	1	02	01	H3240_024_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3240	024	0	1	02	01	H3240_024_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3240	024	0	1	02	01	H3240_024_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3240	024	0	1	02	01	H3240_024_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3251	002	0	1	01	01	H3251_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3251	002	0	1	01	01	H3251_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3251	002	0	1	01	01	H3251_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3251	002	0	1	01	01	H3251_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3251	002	0	1	01	01	H3251_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3281	001	0	1	04	01	H3281_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3281	001	0	1	04	01	H3281_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3281	001	0	1	04	01	H3281_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3281	001	0	1	04	01	H3281_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3281	001	0	1	04	01	H3281_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3281	001	0	1	04	01	H3281_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H3281	003	0	1	04	01	H3281_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3281	003	0	1	04	01	H3281_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3281	003	0	1	04	01	H3281_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3281	003	0	1	04	01	H3281_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3281	003	0	1	04	01	H3281_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3281	003	0	1	04	01	H3281_003_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H3281	005	0	1	04	01	H3281_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3281	005	0	1	04	01	H3281_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3281	005	0	1	04	01	H3281_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3281	005	0	1	04	01	H3281_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3281	005	0	1	04	01	H3281_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3281	005	0	1	04	01	H3281_005_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H3281	007	0	1	04	01	H3281_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3281	007	0	1	04	01	H3281_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3281	007	0	1	04	01	H3281_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3281	007	0	1	04	01	H3281_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3281	007	0	1	04	01	H3281_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3281	007	0	1	04	01	H3281_007_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H3281	009	0	1	04	01	H3281_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3281	009	0	1	04	01	H3281_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3281	009	0	1	04	01	H3281_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3281	009	0	1	04	01	H3281_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3281	009	0	1	04	01	H3281_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3281	009	0	1	04	01	H3281_009_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H3281	010	0	1	04	01	H3281_010_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3281	010	0	1	04	01	H3281_010_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3281	010	0	1	04	01	H3281_010_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3281	010	0	1	04	01	H3281_010_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3281	010	0	1	04	01	H3281_010_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3281	010	0	1	04	01	H3281_010_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H3281	011	0	1	04	01	H3281_011_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3281	011	0	1	04	01	H3281_011_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3281	011	0	1	04	01	H3281_011_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3281	011	0	1	04	01	H3281_011_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3281	011	0	1	04	01	H3281_011_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3281	011	0	1	04	01	H3281_011_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H3288	001	0	1	04	01	H3288_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	001	0	1	04	01	H3288_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	001	0	1	04	01	H3288_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	001	0	1	04	01	H3288_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	001	0	1	04	01	H3288_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	002	0	1	04	01	H3288_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	002	0	1	04	01	H3288_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	002	0	1	04	01	H3288_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	002	0	1	04	01	H3288_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	002	0	1	04	01	H3288_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	003	0	1	04	01	H3288_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	003	0	1	04	01	H3288_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	003	0	1	04	01	H3288_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	003	0	1	04	01	H3288_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	003	0	1	04	01	H3288_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	004	0	1	04	01	H3288_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	004	0	1	04	01	H3288_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	004	0	1	04	01	H3288_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	004	0	1	04	01	H3288_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	004	0	1	04	01	H3288_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	005	0	1	04	01	H3288_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	005	0	1	04	01	H3288_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	005	0	1	04	01	H3288_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	005	0	1	04	01	H3288_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	005	0	1	04	01	H3288_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	006	0	1	04	01	H3288_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	006	0	1	04	01	H3288_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	006	0	1	04	01	H3288_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	006	0	1	04	01	H3288_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	006	0	1	04	01	H3288_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	007	0	1	04	01	H3288_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	007	0	1	04	01	H3288_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	007	0	1	04	01	H3288_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	007	0	1	04	01	H3288_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	007	0	1	04	01	H3288_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	008	0	1	04	01	H3288_008_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	008	0	1	04	01	H3288_008_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	008	0	1	04	01	H3288_008_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	008	0	1	04	01	H3288_008_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	008	0	1	04	01	H3288_008_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	009	0	1	04	01	H3288_009_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	009	0	1	04	01	H3288_009_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	009	0	1	04	01	H3288_009_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	009	0	1	04	01	H3288_009_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	009	0	1	04	01	H3288_009_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	010	0	1	04	01	H3288_010_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	010	0	1	04	01	H3288_010_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	010	0	1	04	01	H3288_010_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	010	0	1	04	01	H3288_010_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	010	0	1	04	01	H3288_010_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	011	0	1	04	01	H3288_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	011	0	1	04	01	H3288_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	011	0	1	04	01	H3288_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	011	0	1	04	01	H3288_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	011	0	1	04	01	H3288_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	012	0	1	04	01	H3288_012_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	012	0	1	04	01	H3288_012_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	012	0	1	04	01	H3288_012_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	012	0	1	04	01	H3288_012_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	012	0	1	04	01	H3288_012_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	013	0	1	04	01	H3288_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	013	0	1	04	01	H3288_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	013	0	1	04	01	H3288_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	013	0	1	04	01	H3288_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	013	0	1	04	01	H3288_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	015	0	1	04	01	H3288_015_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	015	0	1	04	01	H3288_015_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	015	0	1	04	01	H3288_015_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	015	0	1	04	01	H3288_015_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	015	0	1	04	01	H3288_015_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	016	0	1	04	01	H3288_016_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	016	0	1	04	01	H3288_016_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	016	0	1	04	01	H3288_016_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	016	0	1	04	01	H3288_016_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	016	0	1	04	01	H3288_016_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	017	0	1	04	01	H3288_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	017	0	1	04	01	H3288_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	017	0	1	04	01	H3288_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	017	0	1	04	01	H3288_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	017	0	1	04	01	H3288_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	018	0	1	04	01	H3288_018_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	018	0	1	04	01	H3288_018_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	018	0	1	04	01	H3288_018_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	018	0	1	04	01	H3288_018_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	018	0	1	04	01	H3288_018_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	019	0	1	04	01	H3288_019_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	019	0	1	04	01	H3288_019_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	019	0	1	04	01	H3288_019_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	019	0	1	04	01	H3288_019_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	019	0	1	04	01	H3288_019_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	020	0	1	04	01	H3288_020_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	020	0	1	04	01	H3288_020_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	020	0	1	04	01	H3288_020_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	020	0	1	04	01	H3288_020_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	020	0	1	04	01	H3288_020_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	021	0	1	04	01	H3288_021_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	021	0	1	04	01	H3288_021_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	021	0	1	04	01	H3288_021_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	021	0	1	04	01	H3288_021_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	021	0	1	04	01	H3288_021_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	022	0	1	04	01	H3288_022_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	022	0	1	04	01	H3288_022_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	022	0	1	04	01	H3288_022_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	022	0	1	04	01	H3288_022_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	022	0	1	04	01	H3288_022_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	023	0	1	04	01	H3288_023_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	023	0	1	04	01	H3288_023_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	023	0	1	04	01	H3288_023_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	023	0	1	04	01	H3288_023_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	023	0	1	04	01	H3288_023_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	024	0	1	04	01	H3288_024_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	024	0	1	04	01	H3288_024_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	024	0	1	04	01	H3288_024_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	024	0	1	04	01	H3288_024_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	024	0	1	04	01	H3288_024_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	025	0	1	04	01	H3288_025_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	025	0	1	04	01	H3288_025_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	025	0	1	04	01	H3288_025_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	025	0	1	04	01	H3288_025_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	025	0	1	04	01	H3288_025_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	026	0	1	04	01	H3288_026_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	026	0	1	04	01	H3288_026_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	026	0	1	04	01	H3288_026_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	026	0	1	04	01	H3288_026_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	026	0	1	04	01	H3288_026_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	027	0	1	04	01	H3288_027_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	027	0	1	04	01	H3288_027_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	027	0	1	04	01	H3288_027_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	027	0	1	04	01	H3288_027_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	027	0	1	04	01	H3288_027_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	028	0	1	04	01	H3288_028_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	028	0	1	04	01	H3288_028_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	028	0	1	04	01	H3288_028_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	028	0	1	04	01	H3288_028_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	028	0	1	04	01	H3288_028_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	029	0	1	04	01	H3288_029_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	029	0	1	04	01	H3288_029_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	029	0	1	04	01	H3288_029_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	029	0	1	04	01	H3288_029_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	029	0	1	04	01	H3288_029_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	030	0	1	04	01	H3288_030_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	030	0	1	04	01	H3288_030_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	030	0	1	04	01	H3288_030_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	030	0	1	04	01	H3288_030_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	030	0	1	04	01	H3288_030_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	031	0	1	04	01	H3288_031_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	031	0	1	04	01	H3288_031_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	031	0	1	04	01	H3288_031_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	031	0	1	04	01	H3288_031_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	031	0	1	04	01	H3288_031_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	032	0	1	04	01	H3288_032_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	032	0	1	04	01	H3288_032_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	032	0	1	04	01	H3288_032_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	032	0	1	04	01	H3288_032_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	032	0	1	04	01	H3288_032_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	033	0	1	04	01	H3288_033_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	033	0	1	04	01	H3288_033_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	033	0	1	04	01	H3288_033_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	033	0	1	04	01	H3288_033_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	033	0	1	04	01	H3288_033_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	035	0	1	04	01	H3288_035_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	035	0	1	04	01	H3288_035_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	035	0	1	04	01	H3288_035_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	035	0	1	04	01	H3288_035_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	035	0	1	04	01	H3288_035_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	036	0	1	04	01	H3288_036_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	036	0	1	04	01	H3288_036_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	036	0	1	04	01	H3288_036_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	036	0	1	04	01	H3288_036_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	036	0	1	04	01	H3288_036_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	037	0	1	04	01	H3288_037_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	037	0	1	04	01	H3288_037_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	037	0	1	04	01	H3288_037_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	037	0	1	04	01	H3288_037_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	037	0	1	04	01	H3288_037_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	038	0	1	04	01	H3288_038_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	038	0	1	04	01	H3288_038_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	038	0	1	04	01	H3288_038_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	038	0	1	04	01	H3288_038_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	038	0	1	04	01	H3288_038_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	039	0	1	04	01	H3288_039_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	039	0	1	04	01	H3288_039_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	039	0	1	04	01	H3288_039_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	039	0	1	04	01	H3288_039_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	039	0	1	04	01	H3288_039_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	040	0	1	04	01	H3288_040_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	040	0	1	04	01	H3288_040_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	040	0	1	04	01	H3288_040_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	040	0	1	04	01	H3288_040_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	040	0	1	04	01	H3288_040_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	041	0	1	04	01	H3288_041_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	041	0	1	04	01	H3288_041_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	041	0	1	04	01	H3288_041_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	041	0	1	04	01	H3288_041_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	041	0	1	04	01	H3288_041_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	042	0	1	04	01	H3288_042_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	042	0	1	04	01	H3288_042_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	042	0	1	04	01	H3288_042_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	042	0	1	04	01	H3288_042_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	042	0	1	04	01	H3288_042_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	043	0	1	04	01	H3288_043_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	043	0	1	04	01	H3288_043_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	043	0	1	04	01	H3288_043_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	043	0	1	04	01	H3288_043_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	043	0	1	04	01	H3288_043_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	044	0	1	04	01	H3288_044_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	044	0	1	04	01	H3288_044_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	044	0	1	04	01	H3288_044_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	044	0	1	04	01	H3288_044_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	044	0	1	04	01	H3288_044_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	045	0	1	04	01	H3288_045_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	045	0	1	04	01	H3288_045_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	045	0	1	04	01	H3288_045_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	045	0	1	04	01	H3288_045_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	045	0	1	04	01	H3288_045_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	046	0	1	04	01	H3288_046_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	046	0	1	04	01	H3288_046_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	046	0	1	04	01	H3288_046_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	046	0	1	04	01	H3288_046_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	046	0	1	04	01	H3288_046_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	047	0	1	04	01	H3288_047_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	047	0	1	04	01	H3288_047_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	047	0	1	04	01	H3288_047_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	047	0	1	04	01	H3288_047_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	047	0	1	04	01	H3288_047_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3288	048	0	1	04	01	H3288_048_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3288	048	0	1	04	01	H3288_048_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3288	048	0	1	04	01	H3288_048_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3288	048	0	1	04	01	H3288_048_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3288	048	0	1	04	01	H3288_048_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3293	003	0	1	01	01	H3293_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3293	003	0	1	01	01	H3293_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3293	003	0	1	01	01	H3293_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	3						
H3293	003	0	1	01	01	H3293_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3293	003	0	1	01	01	H3293_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3293	004	0	1	01	01	H3293_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3293	004	0	1	01	01	H3293_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3293	004	0	1	01	01	H3293_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	3						
H3293	004	0	1	01	01	H3293_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3293	004	0	1	01	01	H3293_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3293	005	0	1	01	01	H3293_005_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3293	005	0	1	01	01	H3293_005_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3293	005	0	1	01	01	H3293_005_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	3						
H3293	005	0	1	01	01	H3293_005_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3293	005	0	1	01	01	H3293_005_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3305	015	0	1	02	01	H3305_015_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3305	015	0	1	02	01	H3305_015_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3305	015	0	1	02	01	H3305_015_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3305	015	0	1	02	01	H3305_015_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3305	015	0	1	02	01	H3305_015_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3305	021	0	1	02	01	H3305_021_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3305	021	0	1	02	01	H3305_021_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3305	021	0	1	02	01	H3305_021_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3305	021	0	1	02	01	H3305_021_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3305	021	0	1	02	01	H3305_021_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3305	022	0	1	02	01	H3305_022_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3305	022	0	1	02	01	H3305_022_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3305	022	0	1	02	01	H3305_022_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3305	022	0	1	02	01	H3305_022_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3305	022	0	1	02	01	H3305_022_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3305	030	0	1	02	01	H3305_030_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3305	030	0	1	02	01	H3305_030_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3305	030	0	1	02	01	H3305_030_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3305	030	0	1	02	01	H3305_030_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3305	030	0	1	02	01	H3305_030_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3305	032	0	1	02	01	H3305_032_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3305	032	0	1	02	01	H3305_032_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3305	032	0	1	02	01	H3305_032_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3305	032	0	1	02	01	H3305_032_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3305	032	0	1	02	01	H3305_032_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3307	002	0	1	01	01	H3307_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3307	002	0	1	01	01	H3307_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3307	002	0	1	01	01	H3307_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3307	002	0	1	01	01	H3307_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3307	002	0	1	01	01	H3307_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3307	012	0	1	01	01	H3307_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3307	012	0	1	01	01	H3307_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3307	012	0	1	01	01	H3307_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3307	012	0	1	01	01	H3307_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3307	012	0	1	01	01	H3307_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3307	015	0	1	01	01	H3307_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3307	015	0	1	01	01	H3307_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3307	015	0	1	01	01	H3307_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3307	015	0	1	01	01	H3307_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3307	015	0	1	01	01	H3307_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3307	023	0	1	01	01	H3307_023_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3307	023	0	1	01	01	H3307_023_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3307	023	0	1	01	01	H3307_023_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3307	023	0	1	01	01	H3307_023_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3307	023	0	1	01	01	H3307_023_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3307	025	0	1	01	01	H3307_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3307	025	0	1	01	01	H3307_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3307	025	0	1	01	01	H3307_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3307	025	0	1	01	01	H3307_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3307	025	0	1	01	01	H3307_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3312	002	0	1	01	01	H3312_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3312	002	0	1	01	01	H3312_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3312	002	0	1	01	01	H3312_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3312	002	0	1	01	01	H3312_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3312	002	0	1	01	01	H3312_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3312	018	0	1	01	01	H3312_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3312	018	0	1	01	01	H3312_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3312	018	0	1	01	01	H3312_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3312	018	0	1	01	01	H3312_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3312	018	0	1	01	01	H3312_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3312	048	0	1	01	01	H3312_048_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3312	048	0	1	01	01	H3312_048_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3312	048	0	1	01	01	H3312_048_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3312	048	0	1	01	01	H3312_048_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3312	048	0	1	01	01	H3312_048_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3312	062	0	1	01	01	H3312_062_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3312	062	0	1	01	01	H3312_062_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3312	062	0	1	01	01	H3312_062_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3312	062	0	1	01	01	H3312_062_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3312	062	0	1	01	01	H3312_062_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3312	064	0	1	01	01	H3312_064_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3312	064	0	1	01	01	H3312_064_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3312	064	0	1	01	01	H3312_064_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3312	064	0	1	01	01	H3312_064_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3312	064	0	1	01	01	H3312_064_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3312	065	0	1	01	01	H3312_065_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3312	065	0	1	01	01	H3312_065_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3312	065	0	1	01	01	H3312_065_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3312	065	0	1	01	01	H3312_065_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3312	065	0	1	01	01	H3312_065_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3312	068	0	1	01	01	H3312_068_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3312	068	0	1	01	01	H3312_068_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3312	068	0	1	01	01	H3312_068_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3312	068	0	1	01	01	H3312_068_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3312	068	0	1	01	01	H3312_068_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3312	069	0	1	01	01	H3312_069_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3312	069	0	1	01	01	H3312_069_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3312	069	0	1	01	01	H3312_069_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3312	069	0	1	01	01	H3312_069_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3312	069	0	1	01	01	H3312_069_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3312	070	0	1	01	01	H3312_070_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3312	070	0	1	01	01	H3312_070_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3312	070	0	1	01	01	H3312_070_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3312	070	0	1	01	01	H3312_070_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3312	070	0	1	01	01	H3312_070_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	021	1	1	01	01	H3330_021_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	021	1	1	01	01	H3330_021_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	021	1	1	01	01	H3330_021_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	021	1	1	01	01	H3330_021_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	021	1	1	01	01	H3330_021_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	021	2	1	01	01	H3330_021_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	021	2	1	01	01	H3330_021_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	021	2	1	01	01	H3330_021_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	021	2	1	01	01	H3330_021_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	021	2	1	01	01	H3330_021_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	021	3	1	01	01	H3330_021_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	021	3	1	01	01	H3330_021_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	021	3	1	01	01	H3330_021_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	021	3	1	01	01	H3330_021_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	021	3	1	01	01	H3330_021_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	021	4	1	01	01	H3330_021_4	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	021	4	1	01	01	H3330_021_4	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	021	4	1	01	01	H3330_021_4	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	021	4	1	01	01	H3330_021_4	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	021	4	1	01	01	H3330_021_4	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	032	1	1	01	01	H3330_032_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	032	1	1	01	01	H3330_032_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	032	1	1	01	01	H3330_032_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	032	1	1	01	01	H3330_032_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	032	1	1	01	01	H3330_032_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	032	2	1	01	01	H3330_032_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	032	2	1	01	01	H3330_032_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	032	2	1	01	01	H3330_032_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	032	2	1	01	01	H3330_032_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	032	2	1	01	01	H3330_032_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	032	3	1	01	01	H3330_032_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	032	3	1	01	01	H3330_032_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	032	3	1	01	01	H3330_032_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	032	3	1	01	01	H3330_032_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	032	3	1	01	01	H3330_032_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	032	4	1	01	01	H3330_032_4	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	032	4	1	01	01	H3330_032_4	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	032	4	1	01	01	H3330_032_4	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	032	4	1	01	01	H3330_032_4	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	032	4	1	01	01	H3330_032_4	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	036	0	1	01	01	H3330_036_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	036	0	1	01	01	H3330_036_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	036	0	1	01	01	H3330_036_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	036	0	1	01	01	H3330_036_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	036	0	1	01	01	H3330_036_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	038	0	1	01	01	H3330_038_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	038	0	1	01	01	H3330_038_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	038	0	1	01	01	H3330_038_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	038	0	1	01	01	H3330_038_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	038	0	1	01	01	H3330_038_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	039	1	1	01	01	H3330_039_1	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	039	1	1	01	01	H3330_039_1	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	039	1	1	01	01	H3330_039_1	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	039	1	1	01	01	H3330_039_1	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	039	1	1	01	01	H3330_039_1	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	039	2	1	01	01	H3330_039_2	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	039	2	1	01	01	H3330_039_2	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	039	2	1	01	01	H3330_039_2	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	039	2	1	01	01	H3330_039_2	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	039	2	1	01	01	H3330_039_2	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	040	0	1	01	01	H3330_040_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	040	0	1	01	01	H3330_040_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	040	0	1	01	01	H3330_040_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	040	0	1	01	01	H3330_040_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	040	0	1	01	01	H3330_040_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	041	1	1	02	01	H3330_041_1	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	041	1	1	02	01	H3330_041_1	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	041	1	1	02	01	H3330_041_1	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	041	1	1	02	01	H3330_041_1	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	041	1	1	02	01	H3330_041_1	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3330	041	2	1	02	01	H3330_041_2	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3330	041	2	1	02	01	H3330_041_2	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3330	041	2	1	02	01	H3330_041_2	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3330	041	2	1	02	01	H3330_041_2	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3330	041	2	1	02	01	H3330_041_2	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3335	014	0	1	04	01	H3335_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3335	014	0	1	04	01	H3335_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3335	014	0	1	04	01	H3335_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3335	014	0	1	04	01	H3335_014_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3335	014	0	1	04	01	H3335_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3335	015	0	1	04	01	H3335_015_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3335	015	0	1	04	01	H3335_015_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3335	015	0	1	04	01	H3335_015_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3335	015	0	1	04	01	H3335_015_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3335	015	0	1	04	01	H3335_015_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3335	018	0	1	04	01	H3335_018_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3335	018	0	1	04	01	H3335_018_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3335	018	0	1	04	01	H3335_018_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3335	018	0	1	04	01	H3335_018_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3335	018	0	1	04	01	H3335_018_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3335	038	0	1	04	01	H3335_038_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3335	038	0	1	04	01	H3335_038_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3335	038	0	1	04	01	H3335_038_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3335	038	0	1	04	01	H3335_038_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3335	038	0	1	04	01	H3335_038_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3335	053	0	1	04	01	H3335_053_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3335	053	0	1	04	01	H3335_053_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3335	053	0	1	04	01	H3335_053_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3335	053	0	1	04	01	H3335_053_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3335	053	0	1	04	01	H3335_053_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3342	023	1	1	04	01	H3342_023_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3342	023	1	1	04	01	H3342_023_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3342	023	1	1	04	01	H3342_023_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3342	023	1	1	04	01	H3342_023_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3342	023	1	1	04	01	H3342_023_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3342	023	1	1	04	01	H3342_023_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3342	023	2	1	04	01	H3342_023_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3342	023	2	1	04	01	H3342_023_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3342	023	2	1	04	01	H3342_023_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3342	023	2	1	04	01	H3342_023_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3342	023	2	1	04	01	H3342_023_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3342	023	2	1	04	01	H3342_023_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3344	005	0	1	04	01	H3344_005_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3344	005	0	1	04	01	H3344_005_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3344	005	0	1	04	01	H3344_005_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3344	005	0	1	04	01	H3344_005_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3344	005	0	1	04	01	H3344_005_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3344	010	0	1	04	01	H3344_010_0	16	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3344	010	0	1	04	01	H3344_010_0	16	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3344	010	0	1	04	01	H3344_010_0	16	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3344	010	0	1	04	01	H3344_010_0	16	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3344	010	0	1	04	01	H3344_010_0	16	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3347	009	0	1	01	01	H3347_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3347	009	0	1	01	01	H3347_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3347	009	0	1	01	01	H3347_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3347	009	0	1	01	01	H3347_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3347	009	0	1	01	01	H3347_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3347	015	0	1	01	01	H3347_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3347	015	0	1	01	01	H3347_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3347	015	0	1	01	01	H3347_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3347	015	0	1	01	01	H3347_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3347	015	0	1	01	01	H3347_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	002	0	1	02	01	H3351_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	002	0	1	02	01	H3351_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	002	0	1	02	01	H3351_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	002	0	1	02	01	H3351_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	002	0	1	02	01	H3351_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	006	0	1	02	01	H3351_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	006	0	1	02	01	H3351_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	006	0	1	02	01	H3351_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	006	0	1	02	01	H3351_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	006	0	1	02	01	H3351_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	010	0	1	01	01	H3351_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	010	0	1	01	01	H3351_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	010	0	1	01	01	H3351_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	010	0	1	01	01	H3351_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	010	0	1	01	01	H3351_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	011	0	1	01	01	H3351_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	011	0	1	01	01	H3351_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	011	0	1	01	01	H3351_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	011	0	1	01	01	H3351_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	011	0	1	01	01	H3351_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	012	0	1	02	01	H3351_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	012	0	1	02	01	H3351_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	012	0	1	02	01	H3351_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	012	0	1	02	01	H3351_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	012	0	1	02	01	H3351_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	013	0	1	02	01	H3351_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	013	0	1	02	01	H3351_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	013	0	1	02	01	H3351_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	013	0	1	02	01	H3351_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	013	0	1	02	01	H3351_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	015	0	1	02	01	H3351_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	015	0	1	02	01	H3351_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	015	0	1	02	01	H3351_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	015	0	1	02	01	H3351_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	015	0	1	02	01	H3351_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	016	0	1	01	01	H3351_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	016	0	1	01	01	H3351_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	016	0	1	01	01	H3351_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	016	0	1	01	01	H3351_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	016	0	1	01	01	H3351_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	017	0	1	01	01	H3351_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	017	0	1	01	01	H3351_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	017	0	1	01	01	H3351_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	017	0	1	01	01	H3351_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	017	0	1	01	01	H3351_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	018	0	1	02	01	H3351_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	018	0	1	02	01	H3351_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	018	0	1	02	01	H3351_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	018	0	1	02	01	H3351_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	018	0	1	02	01	H3351_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3351	019	0	1	02	01	H3351_019_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3351	019	0	1	02	01	H3351_019_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3351	019	0	1	02	01	H3351_019_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3351	019	0	1	02	01	H3351_019_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3351	019	0	1	02	01	H3351_019_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3359	001	0	1	01	01	H3359_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3359	001	0	1	01	01	H3359_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3359	001	0	1	01	01	H3359_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3359	001	0	1	01	01	H3359_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3359	001	0	1	01	01	H3359_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3362	017	0	1	01	01	H3362_017_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3362	017	0	1	01	01	H3362_017_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3362	017	0	1	01	01	H3362_017_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3362	017	0	1	01	01	H3362_017_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3362	017	0	1	01	01	H3362_017_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3362	020	0	1	01	01	H3362_020_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3362	020	0	1	01	01	H3362_020_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3362	020	0	1	01	01	H3362_020_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3362	020	0	1	01	01	H3362_020_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3362	020	0	1	01	01	H3362_020_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3362	033	0	1	01	01	H3362_033_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3362	033	0	1	01	01	H3362_033_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3362	033	0	1	01	01	H3362_033_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3362	033	0	1	01	01	H3362_033_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3362	033	0	1	01	01	H3362_033_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3362	035	0	1	01	01	H3362_035_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3362	035	0	1	01	01	H3362_035_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3362	035	0	1	01	01	H3362_035_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3362	035	0	1	01	01	H3362_035_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3362	035	0	1	01	01	H3362_035_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3362	035	0	1	01	01	H3362_035_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3362	038	0	1	01	01	H3362_038_0	14	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3362	038	0	1	01	01	H3362_038_0	14	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3362	038	0	1	01	01	H3362_038_0	14	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3362	038	0	1	01	01	H3362_038_0	14	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3362	038	0	1	01	01	H3362_038_0	14	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3379	001	0	1	01	01	H3379_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3379	001	0	1	01	01	H3379_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3379	001	0	1	01	01	H3379_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3379	001	0	1	01	01	H3379_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3379	001	0	1	01	01	H3379_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3379	039	0	1	01	01	H3379_039_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3379	039	0	1	01	01	H3379_039_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3379	039	0	1	01	01	H3379_039_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3379	039	0	1	01	01	H3379_039_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3379	039	0	1	01	01	H3379_039_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3379	040	0	1	01	01	H3379_040_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3379	040	0	1	01	01	H3379_040_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3379	040	0	1	01	01	H3379_040_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3379	040	0	1	01	01	H3379_040_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3379	040	0	1	01	01	H3379_040_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3379	041	0	1	01	01	H3379_041_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3379	041	0	1	01	01	H3379_041_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3379	041	0	1	01	01	H3379_041_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3379	041	0	1	01	01	H3379_041_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3379	041	0	1	01	01	H3379_041_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3384	013	0	1	01	01	H3384_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3384	013	0	1	01	01	H3384_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3384	013	0	1	01	01	H3384_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3384	013	0	1	01	01	H3384_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3384	013	0	1	01	01	H3384_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3384	019	0	1	01	01	H3384_019_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3384	019	0	1	01	01	H3384_019_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3384	019	0	1	01	01	H3384_019_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3384	019	0	1	01	01	H3384_019_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3384	019	0	1	01	01	H3384_019_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3384	058	0	1	01	01	H3384_058_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3384	058	0	1	01	01	H3384_058_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3384	058	0	1	01	01	H3384_058_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3384	058	0	1	01	01	H3384_058_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3384	058	0	1	01	01	H3384_058_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3384	059	0	1	01	01	H3384_059_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3384	059	0	1	01	01	H3384_059_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3384	059	0	1	01	01	H3384_059_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3384	059	0	1	01	01	H3384_059_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3384	059	0	1	01	01	H3384_059_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3384	062	0	1	01	01	H3384_062_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3384	062	0	1	01	01	H3384_062_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3384	062	0	1	01	01	H3384_062_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3384	062	0	1	01	01	H3384_062_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3384	062	0	1	01	01	H3384_062_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3384	063	0	1	01	01	H3384_063_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3384	063	0	1	01	01	H3384_063_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3384	063	0	1	01	01	H3384_063_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3384	063	0	1	01	01	H3384_063_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3384	063	0	1	01	01	H3384_063_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3384	064	0	1	01	01	H3384_064_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3384	064	0	1	01	01	H3384_064_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3384	064	0	1	01	01	H3384_064_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3384	064	0	1	01	01	H3384_064_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3384	064	0	1	01	01	H3384_064_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3388	002	0	1	01	01	H3388_002_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3388	002	0	1	01	01	H3388_002_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3388	002	0	1	01	01	H3388_002_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3388	002	0	1	01	01	H3388_002_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3388	002	0	1	01	01	H3388_002_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3388	004	0	1	01	01	H3388_004_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3388	004	0	1	01	01	H3388_004_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3388	004	0	1	01	01	H3388_004_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3388	004	0	1	01	01	H3388_004_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3388	004	0	1	01	01	H3388_004_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3388	013	0	1	01	01	H3388_013_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3388	013	0	1	01	01	H3388_013_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3388	013	0	1	01	01	H3388_013_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3388	013	0	1	01	01	H3388_013_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3388	013	0	1	01	01	H3388_013_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3388	014	0	1	01	01	H3388_014_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3388	014	0	1	01	01	H3388_014_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3388	014	0	1	01	01	H3388_014_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3388	014	0	1	01	01	H3388_014_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3388	014	0	1	01	01	H3388_014_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3404	003	1	1	04	01	H3404_003_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3404	003	1	1	04	01	H3404_003_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3404	003	1	1	04	01	H3404_003_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3404	003	1	1	04	01	H3404_003_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3404	003	1	1	04	01	H3404_003_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3404	003	1	1	04	01	H3404_003_1	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3404	003	2	1	04	01	H3404_003_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3404	003	2	1	04	01	H3404_003_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3404	003	2	1	04	01	H3404_003_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3404	003	2	1	04	01	H3404_003_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3404	003	2	1	04	01	H3404_003_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3404	003	2	1	04	01	H3404_003_2	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3416	001	6	1	04	01	H3416_001_6	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3416	001	6	1	04	01	H3416_001_6	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3416	001	6	1	04	01	H3416_001_6	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3416	001	6	1	04	01	H3416_001_6	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3416	001	6	1	04	01	H3416_001_6	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3416	001	7	1	04	01	H3416_001_7	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3416	001	7	1	04	01	H3416_001_7	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3416	001	7	1	04	01	H3416_001_7	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3416	001	7	1	04	01	H3416_001_7	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3416	001	7	1	04	01	H3416_001_7	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3416	002	4	1	04	01	H3416_002_4	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3416	002	4	1	04	01	H3416_002_4	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3416	002	4	1	04	01	H3416_002_4	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3416	002	4	1	04	01	H3416_002_4	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3416	002	4	1	04	01	H3416_002_4	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3416	002	5	1	04	01	H3416_002_5	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3416	002	5	1	04	01	H3416_002_5	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3416	002	5	1	04	01	H3416_002_5	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3416	002	5	1	04	01	H3416_002_5	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3416	002	5	1	04	01	H3416_002_5	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3418	001	0	1	04	01	H3418_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3418	001	0	1	04	01	H3418_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3418	001	0	1	04	01	H3418_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3418	001	0	1	04	01	H3418_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3418	001	0	1	04	01	H3418_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3419	002	0	1	01	01	H3419_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H3419	002	0	1	01	01	H3419_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H3419	002	0	1	01	01	H3419_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H3419	002	0	1	01	01	H3419_002_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H3419	002	0	1	01	01	H3419_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H3442	001	0	1	04	01	H3442_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3442	001	0	1	04	01	H3442_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3442	001	0	1	04	01	H3442_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3442	001	0	1	04	01	H3442_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3442	001	0	1	04	01	H3442_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3442	003	0	1	04	01	H3442_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3442	003	0	1	04	01	H3442_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3442	003	0	1	04	01	H3442_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3442	003	0	1	04	01	H3442_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3442	003	0	1	04	01	H3442_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3442	004	0	1	04	01	H3442_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3442	004	0	1	04	01	H3442_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3442	004	0	1	04	01	H3442_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3442	004	0	1	04	01	H3442_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3442	004	0	1	04	01	H3442_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3442	006	0	1	04	01	H3442_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3442	006	0	1	04	01	H3442_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3442	006	0	1	04	01	H3442_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3442	006	0	1	04	01	H3442_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3442	006	0	1	04	01	H3442_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3442	007	0	1	04	01	H3442_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3442	007	0	1	04	01	H3442_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3442	007	0	1	04	01	H3442_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3442	007	0	1	04	01	H3442_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3442	007	0	1	04	01	H3442_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3447	001	0	1	01	01	H3447_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H3447	001	0	1	01	01	H3447_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H3447	001	0	1	01	01	H3447_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H3447	001	0	1	01	01	H3447_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H3447	001	0	1	01	01	H3447_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H3447	001	0	1	01	01	H3447_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H3447	003	0	1	01	01	H3447_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H3447	003	0	1	01	01	H3447_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H3447	003	0	1	01	01	H3447_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H3447	003	0	1	01	01	H3447_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H3447	003	0	1	01	01	H3447_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H3447	003	0	1	01	01	H3447_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H3447	004	0	1	01	01	H3447_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H3447	004	0	1	01	01	H3447_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H3447	004	0	1	01	01	H3447_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H3447	004	0	1	01	01	H3447_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H3447	004	0	1	01	01	H3447_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H3447	004	0	1	01	01	H3447_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H3447	005	0	1	01	01	H3447_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H3447	005	0	1	01	01	H3447_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H3447	005	0	1	01	01	H3447_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H3447	005	0	1	01	01	H3447_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H3447	005	0	1	01	01	H3447_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H3447	005	0	1	01	01	H3447_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H3447	010	0	1	01	01	H3447_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H3447	010	0	1	01	01	H3447_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H3447	010	0	1	01	01	H3447_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H3447	010	0	1	01	01	H3447_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H3447	010	0	1	01	01	H3447_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H3447	010	0	1	01	01	H3447_010_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H3447	011	0	1	01	01	H3447_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	011	0	1	01	01	H3447_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	011	0	1	01	01	H3447_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	011	0	1	01	01	H3447_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	011	0	1	01	01	H3447_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	011	0	1	01	01	H3447_011_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	012	0	1	01	01	H3447_012_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	012	0	1	01	01	H3447_012_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	012	0	1	01	01	H3447_012_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	012	0	1	01	01	H3447_012_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	012	0	1	01	01	H3447_012_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	012	0	1	01	01	H3447_012_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	013	0	1	01	01	H3447_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3447	013	0	1	01	01	H3447_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	013	0	1	01	01	H3447_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	013	0	1	01	01	H3447_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	013	0	1	01	01	H3447_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	013	0	1	01	01	H3447_013_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	014	0	1	01	01	H3447_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3447	014	0	1	01	01	H3447_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	014	0	1	01	01	H3447_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	014	0	1	01	01	H3447_014_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	014	0	1	01	01	H3447_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	014	0	1	01	01	H3447_014_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	018	0	1	01	01	H3447_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	018	0	1	01	01	H3447_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	018	0	1	01	01	H3447_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	018	0	1	01	01	H3447_018_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	018	0	1	01	01	H3447_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	018	0	1	01	01	H3447_018_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	019	0	1	01	01	H3447_019_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	019	0	1	01	01	H3447_019_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	019	0	1	01	01	H3447_019_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	019	0	1	01	01	H3447_019_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	019	0	1	01	01	H3447_019_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	019	0	1	01	01	H3447_019_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	020	0	1	01	01	H3447_020_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	020	0	1	01	01	H3447_020_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	020	0	1	01	01	H3447_020_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	020	0	1	01	01	H3447_020_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	020	0	1	01	01	H3447_020_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	020	0	1	01	01	H3447_020_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	021	0	1	01	01	H3447_021_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	021	0	1	01	01	H3447_021_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	021	0	1	01	01	H3447_021_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	021	0	1	01	01	H3447_021_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	021	0	1	01	01	H3447_021_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	021	0	1	01	01	H3447_021_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	022	0	1	01	01	H3447_022_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	022	0	1	01	01	H3447_022_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	022	0	1	01	01	H3447_022_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	022	0	1	01	01	H3447_022_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	022	0	1	01	01	H3447_022_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	022	0	1	01	01	H3447_022_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	023	0	1	01	01	H3447_023_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	023	0	1	01	01	H3447_023_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	023	0	1	01	01	H3447_023_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	023	0	1	01	01	H3447_023_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	023	0	1	01	01	H3447_023_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	023	0	1	01	01	H3447_023_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	024	0	1	01	01	H3447_024_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	024	0	1	01	01	H3447_024_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	024	0	1	01	01	H3447_024_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	024	0	1	01	01	H3447_024_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	024	0	1	01	01	H3447_024_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	024	0	1	01	01	H3447_024_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	025	0	1	01	01	H3447_025_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3447	025	0	1	01	01	H3447_025_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	025	0	1	01	01	H3447_025_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	025	0	1	01	01	H3447_025_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	025	0	1	01	01	H3447_025_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	025	0	1	01	01	H3447_025_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	026	0	1	01	01	H3447_026_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H3447	026	0	1	01	01	H3447_026_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H3447	026	0	1	01	01	H3447_026_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H3447	026	0	1	01	01	H3447_026_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H3447	026	0	1	01	01	H3447_026_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H3447	026	0	1	01	01	H3447_026_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H3447	027	0	1	01	01	H3447_027_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3447	027	0	1	01	01	H3447_027_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	027	0	1	01	01	H3447_027_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	027	0	1	01	01	H3447_027_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	027	0	1	01	01	H3447_027_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	027	0	1	01	01	H3447_027_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	028	0	1	01	01	H3447_028_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3447	028	0	1	01	01	H3447_028_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	028	0	1	01	01	H3447_028_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	028	0	1	01	01	H3447_028_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	028	0	1	01	01	H3447_028_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	028	0	1	01	01	H3447_028_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	030	0	1	01	01	H3447_030_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	030	0	1	01	01	H3447_030_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	030	0	1	01	01	H3447_030_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	030	0	1	01	01	H3447_030_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	030	0	1	01	01	H3447_030_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	030	0	1	01	01	H3447_030_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3447	031	0	1	01	01	H3447_031_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3447	031	0	1	01	01	H3447_031_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3447	031	0	1	01	01	H3447_031_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3447	031	0	1	01	01	H3447_031_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3447	031	0	1	01	01	H3447_031_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3447	031	0	1	01	01	H3447_031_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3449	023	1	1	01	01	H3449_023_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3449	023	1	1	01	01	H3449_023_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3449	023	1	1	01	01	H3449_023_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3449	023	1	1	01	01	H3449_023_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3449	023	1	1	01	01	H3449_023_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3449	023	1	1	01	01	H3449_023_1	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3449	023	2	1	01	01	H3449_023_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3449	023	2	1	01	01	H3449_023_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3449	023	2	1	01	01	H3449_023_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3449	023	2	1	01	01	H3449_023_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3449	023	2	1	01	01	H3449_023_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3449	023	2	1	01	01	H3449_023_2	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3449	023	4	1	01	01	H3449_023_4	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3449	023	4	1	01	01	H3449_023_4	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3449	023	4	1	01	01	H3449_023_4	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3449	023	4	1	01	01	H3449_023_4	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3449	023	4	1	01	01	H3449_023_4	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3449	023	4	1	01	01	H3449_023_4	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3449	023	5	1	01	01	H3449_023_5	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3449	023	5	1	01	01	H3449_023_5	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3449	023	5	1	01	01	H3449_023_5	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3449	023	5	1	01	01	H3449_023_5	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3449	023	5	1	01	01	H3449_023_5	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3449	023	5	1	01	01	H3449_023_5	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3449	024	1	1	01	01	H3449_024_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3449	024	1	1	01	01	H3449_024_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3449	024	1	1	01	01	H3449_024_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3449	024	1	1	01	01	H3449_024_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3449	024	1	1	01	01	H3449_024_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3449	024	1	1	01	01	H3449_024_1	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3449	024	2	1	01	01	H3449_024_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3449	024	2	1	01	01	H3449_024_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3449	024	2	1	01	01	H3449_024_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3449	024	2	1	01	01	H3449_024_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3449	024	2	1	01	01	H3449_024_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3449	024	2	1	01	01	H3449_024_2	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3449	024	3	1	01	01	H3449_024_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3449	024	3	1	01	01	H3449_024_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3449	024	3	1	01	01	H3449_024_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3449	024	3	1	01	01	H3449_024_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3449	024	3	1	01	01	H3449_024_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3449	024	3	1	01	01	H3449_024_3	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3449	025	0	1	01	01	H3449_025_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3449	025	0	1	01	01	H3449_025_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3449	025	0	1	01	01	H3449_025_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3449	025	0	1	01	01	H3449_025_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3449	025	0	1	01	01	H3449_025_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3449	025	0	1	01	01	H3449_025_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3449	026	0	1	01	01	H3449_026_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3449	026	0	1	01	01	H3449_026_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3449	026	0	1	01	01	H3449_026_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3449	026	0	1	01	01	H3449_026_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3449	026	0	1	01	01	H3449_026_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3449	026	0	1	01	01	H3449_026_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3464	001	0	1	01	01	H3464_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3464	001	0	1	01	01	H3464_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3464	001	0	1	01	01	H3464_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3464	001	0	1	01	01	H3464_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3464	001	0	1	01	01	H3464_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3464	002	0	1	01	01	H3464_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3464	002	0	1	01	01	H3464_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3464	002	0	1	01	01	H3464_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3464	002	0	1	01	01	H3464_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3464	002	0	1	01	01	H3464_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3464	003	0	1	01	01	H3464_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3464	003	0	1	01	01	H3464_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3464	003	0	1	01	01	H3464_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3464	003	0	1	01	01	H3464_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3464	003	0	1	01	01	H3464_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3464	004	0	1	01	01	H3464_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3464	004	0	1	01	01	H3464_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3464	004	0	1	01	01	H3464_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3464	004	0	1	01	01	H3464_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3464	004	0	1	01	01	H3464_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3471	001	0	1	01	01	H3471_001_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3471	001	0	1	01	01	H3471_001_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3471	001	0	1	01	01	H3471_001_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3471	001	0	1	01	01	H3471_001_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3471	001	0	1	01	01	H3471_001_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3471	002	0	1	01	01	H3471_002_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3471	002	0	1	01	01	H3471_002_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3471	002	0	1	01	01	H3471_002_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3471	002	0	1	01	01	H3471_002_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3471	002	0	1	01	01	H3471_002_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3471	004	0	1	01	01	H3471_004_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3471	004	0	1	01	01	H3471_004_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3471	004	0	1	01	01	H3471_004_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3471	004	0	1	01	01	H3471_004_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3471	004	0	1	01	01	H3471_004_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3471	005	0	1	01	01	H3471_005_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3471	005	0	1	01	01	H3471_005_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3471	005	0	1	01	01	H3471_005_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3471	005	0	1	01	01	H3471_005_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3471	005	0	1	01	01	H3471_005_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3471	010	0	1	01	01	H3471_010_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3471	010	0	1	01	01	H3471_010_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3471	010	0	1	01	01	H3471_010_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3471	010	0	1	01	01	H3471_010_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3471	010	0	1	01	01	H3471_010_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3471	013	0	1	02	01	H3471_013_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3471	013	0	1	02	01	H3471_013_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3471	013	0	1	02	01	H3471_013_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3471	013	0	1	02	01	H3471_013_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3471	013	0	1	02	01	H3471_013_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3471	014	0	1	02	01	H3471_014_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3471	014	0	1	02	01	H3471_014_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3471	014	0	1	02	01	H3471_014_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3471	014	0	1	02	01	H3471_014_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3471	014	0	1	02	01	H3471_014_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3471	017	0	1	01	01	H3471_017_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3471	017	0	1	01	01	H3471_017_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3471	017	0	1	01	01	H3471_017_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3471	017	0	1	01	01	H3471_017_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3471	017	0	1	01	01	H3471_017_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3471	018	0	1	02	01	H3471_018_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3471	018	0	1	02	01	H3471_018_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3471	018	0	1	02	01	H3471_018_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3471	018	0	1	02	01	H3471_018_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3471	018	0	1	02	01	H3471_018_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3499	002	0	1	01	01	H3499_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3499	002	0	1	01	01	H3499_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3499	002	0	1	01	01	H3499_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3499	002	0	1	01	01	H3499_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3499	002	0	1	01	01	H3499_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3499	002	0	1	01	01	H3499_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3499	005	0	1	01	01	H3499_005_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3499	005	0	1	01	01	H3499_005_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3499	005	0	1	01	01	H3499_005_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3499	005	0	1	01	01	H3499_005_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3499	005	0	1	01	01	H3499_005_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3499	007	0	1	01	01	H3499_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3499	007	0	1	01	01	H3499_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3499	007	0	1	01	01	H3499_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3499	007	0	1	01	01	H3499_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3499	007	0	1	01	01	H3499_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3499	007	0	1	01	01	H3499_007_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3499	008	0	1	01	01	H3499_008_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3499	008	0	1	01	01	H3499_008_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3499	008	0	1	01	01	H3499_008_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3499	008	0	1	01	01	H3499_008_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3499	008	0	1	01	01	H3499_008_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3528	006	0	1	02	01	H3528_006_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3528	006	0	1	02	01	H3528_006_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3528	006	0	1	02	01	H3528_006_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3528	006	0	1	02	01	H3528_006_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3528	006	0	1	02	01	H3528_006_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3528	010	0	1	01	01	H3528_010_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3528	010	0	1	01	01	H3528_010_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3528	010	0	1	01	01	H3528_010_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3528	010	0	1	01	01	H3528_010_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3528	010	0	1	01	01	H3528_010_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3528	011	1	1	02	01	H3528_011_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3528	011	1	1	02	01	H3528_011_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3528	011	1	1	02	01	H3528_011_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3528	011	1	1	02	01	H3528_011_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3528	011	1	1	02	01	H3528_011_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3528	011	2	1	02	01	H3528_011_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3528	011	2	1	02	01	H3528_011_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3528	011	2	1	02	01	H3528_011_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3528	011	2	1	02	01	H3528_011_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3528	011	2	1	02	01	H3528_011_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3528	014	0	1	01	01	H3528_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3528	014	0	1	01	01	H3528_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3528	014	0	1	01	01	H3528_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3528	014	0	1	01	01	H3528_014_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3528	014	0	1	01	01	H3528_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3528	015	0	1	02	01	H3528_015_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3528	015	0	1	02	01	H3528_015_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3528	015	0	1	02	01	H3528_015_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3528	015	0	1	02	01	H3528_015_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3528	015	0	1	02	01	H3528_015_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3528	016	0	1	01	01	H3528_016_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3528	016	0	1	01	01	H3528_016_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3528	016	0	1	01	01	H3528_016_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3528	016	0	1	01	01	H3528_016_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3528	016	0	1	01	01	H3528_016_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3528	017	0	1	01	01	H3528_017_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3528	017	0	1	01	01	H3528_017_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3528	017	0	1	01	01	H3528_017_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3528	017	0	1	01	01	H3528_017_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3528	017	0	1	01	01	H3528_017_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	001	0	1	01	01	H3533_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	001	0	1	01	01	H3533_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	001	0	1	01	01	H3533_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	001	0	1	01	01	H3533_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	001	0	1	01	01	H3533_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	002	0	1	01	01	H3533_002_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	002	0	1	01	01	H3533_002_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	002	0	1	01	01	H3533_002_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	002	0	1	01	01	H3533_002_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	002	0	1	01	01	H3533_002_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	006	0	1	01	01	H3533_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	006	0	1	01	01	H3533_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	006	0	1	01	01	H3533_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	006	0	1	01	01	H3533_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	006	0	1	01	01	H3533_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	010	0	1	01	01	H3533_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	010	0	1	01	01	H3533_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	010	0	1	01	01	H3533_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	010	0	1	01	01	H3533_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	010	0	1	01	01	H3533_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	013	0	1	01	01	H3533_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	013	0	1	01	01	H3533_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	013	0	1	01	01	H3533_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	013	0	1	01	01	H3533_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	013	0	1	01	01	H3533_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	027	0	1	01	01	H3533_027_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	027	0	1	01	01	H3533_027_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	027	0	1	01	01	H3533_027_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	027	0	1	01	01	H3533_027_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	027	0	1	01	01	H3533_027_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	031	0	1	01	01	H3533_031_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	031	0	1	01	01	H3533_031_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	031	0	1	01	01	H3533_031_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	031	0	1	01	01	H3533_031_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	031	0	1	01	01	H3533_031_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	032	1	1	01	01	H3533_032_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	032	1	1	01	01	H3533_032_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	032	1	1	01	01	H3533_032_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	032	1	1	01	01	H3533_032_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	032	1	1	01	01	H3533_032_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	032	2	1	01	01	H3533_032_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	032	2	1	01	01	H3533_032_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	032	2	1	01	01	H3533_032_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	032	2	1	01	01	H3533_032_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	032	2	1	01	01	H3533_032_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3533	033	0	1	01	01	H3533_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3533	033	0	1	01	01	H3533_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3533	033	0	1	01	01	H3533_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3533	033	0	1	01	01	H3533_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3533	033	0	1	01	01	H3533_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3536	002	0	1	01	01	H3536_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3536	002	0	1	01	01	H3536_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3536	002	0	1	01	01	H3536_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3536	002	0	1	01	01	H3536_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3536	002	0	1	01	01	H3536_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3536	002	0	1	01	01	H3536_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3536	004	0	1	01	01	H3536_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3536	004	0	1	01	01	H3536_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3536	004	0	1	01	01	H3536_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3536	004	0	1	01	01	H3536_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3536	004	0	1	01	01	H3536_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3536	004	0	1	01	01	H3536_004_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3536	005	0	1	01	01	H3536_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H3536	005	0	1	01	01	H3536_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3536	005	0	1	01	01	H3536_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3536	005	0	1	01	01	H3536_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3536	005	0	1	01	01	H3536_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3536	005	0	1	01	01	H3536_005_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3554	001	0	1	04	01	H3554_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	001	0	1	04	01	H3554_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	001	0	1	04	01	H3554_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	001	0	1	04	01	H3554_001_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	001	0	1	04	01	H3554_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	001	0	1	04	01	H3554_001_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3554	002	0	1	04	01	H3554_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	002	0	1	04	01	H3554_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	002	0	1	04	01	H3554_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	002	0	1	04	01	H3554_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	002	0	1	04	01	H3554_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	002	0	1	04	01	H3554_002_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3554	003	0	1	04	01	H3554_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	003	0	1	04	01	H3554_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	003	0	1	04	01	H3554_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	003	0	1	04	01	H3554_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	003	0	1	04	01	H3554_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	003	0	1	04	01	H3554_003_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3554	004	0	1	04	01	H3554_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	004	0	1	04	01	H3554_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	004	0	1	04	01	H3554_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	004	0	1	04	01	H3554_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	004	0	1	04	01	H3554_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	004	0	1	04	01	H3554_004_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3554	005	0	1	04	01	H3554_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	005	0	1	04	01	H3554_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	005	0	1	04	01	H3554_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	005	0	1	04	01	H3554_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	005	0	1	04	01	H3554_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	005	0	1	04	01	H3554_005_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3554	006	0	1	04	01	H3554_006_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	006	0	1	04	01	H3554_006_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	006	0	1	04	01	H3554_006_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	006	0	1	04	01	H3554_006_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	006	0	1	04	01	H3554_006_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	006	0	1	04	01	H3554_006_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3554	007	0	1	04	01	H3554_007_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	007	0	1	04	01	H3554_007_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	007	0	1	04	01	H3554_007_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	007	0	1	04	01	H3554_007_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	007	0	1	04	01	H3554_007_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	007	0	1	04	01	H3554_007_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3554	008	0	1	04	01	H3554_008_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	008	0	1	04	01	H3554_008_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	008	0	1	04	01	H3554_008_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	008	0	1	04	01	H3554_008_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	008	0	1	04	01	H3554_008_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	008	0	1	04	01	H3554_008_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3554	009	0	1	04	01	H3554_009_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	009	0	1	04	01	H3554_009_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	009	0	1	04	01	H3554_009_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	009	0	1	04	01	H3554_009_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	009	0	1	04	01	H3554_009_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	009	0	1	04	01	H3554_009_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3554	010	0	1	04	01	H3554_010_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3554	010	0	1	04	01	H3554_010_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3554	010	0	1	04	01	H3554_010_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3554	010	0	1	04	01	H3554_010_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3554	010	0	1	04	01	H3554_010_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3554	010	0	1	04	01	H3554_010_0	11	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H3557	001	0	1	04	01	H3557_001_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3557	001	0	1	04	01	H3557_001_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3557	001	0	1	04	01	H3557_001_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3557	001	0	1	04	01	H3557_001_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3557	001	0	1	04	01	H3557_001_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3561	001	0	1	01	01	H3561_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3561	001	0	1	01	01	H3561_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3561	001	0	1	01	01	H3561_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3561	001	0	1	01	01	H3561_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3561	001	0	1	01	01	H3561_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3561	002	0	1	01	01	H3561_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3561	002	0	1	01	01	H3561_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3561	002	0	1	01	01	H3561_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3561	002	0	1	01	01	H3561_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3561	002	0	1	01	01	H3561_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3561	004	0	1	01	01	H3561_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3561	004	0	1	01	01	H3561_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3561	004	0	1	01	01	H3561_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3561	004	0	1	01	01	H3561_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3561	004	0	1	01	01	H3561_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3561	005	0	1	01	01	H3561_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3561	005	0	1	01	01	H3561_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3561	005	0	1	01	01	H3561_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3561	005	0	1	01	01	H3561_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3561	005	0	1	01	01	H3561_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3561	006	0	1	01	01	H3561_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3561	006	0	1	01	01	H3561_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3561	006	0	1	01	01	H3561_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3561	006	0	1	01	01	H3561_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3561	006	0	1	01	01	H3561_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3572	001	0	1	01	01	H3572_001_0	4	Generic	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H3572	001	0	1	01	01	H3572_001_0	4	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H3572	001	0	1	01	01	H3572_001_0	4	Non-Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H3572	001	0	1	01	01	H3572_001_0	4	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H3572	001	0	1	01	01	H3572_001_0	4	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	01	1						
H3597	001	0	1	01	01	H3597_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3597	001	0	1	01	01	H3597_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3597	001	0	1	01	01	H3597_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3597	001	0	1	01	01	H3597_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3597	001	0	1	01	01	H3597_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3597	007	0	1	01	01	H3597_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3597	007	0	1	01	01	H3597_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3597	007	0	1	01	01	H3597_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3597	009	0	1	01	01	H3597_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3597	009	0	1	01	01	H3597_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3597	009	0	1	01	01	H3597_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3597	011	0	1	02	01	H3597_011_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3597	011	0	1	02	01	H3597_011_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3597	011	0	1	02	01	H3597_011_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3597	011	0	1	02	01	H3597_011_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3597	011	0	1	02	01	H3597_011_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3632	001	0	1	04	01	H3632_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3632	001	0	1	04	01	H3632_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3632	001	0	1	04	01	H3632_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3632	001	0	1	04	01	H3632_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3632	001	0	1	04	01	H3632_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3653	004	0	1	01	01	H3653_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3653	004	0	1	01	01	H3653_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3653	004	0	1	01	01	H3653_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3653	004	0	1	01	01	H3653_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3653	004	0	1	01	01	H3653_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3653	015	0	1	01	01	H3653_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3653	015	0	1	01	01	H3653_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3653	015	0	1	01	01	H3653_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3653	015	0	1	01	01	H3653_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3653	015	0	1	01	01	H3653_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3653	022	0	1	01	01	H3653_022_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3653	022	0	1	01	01	H3653_022_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3653	022	0	1	01	01	H3653_022_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3653	022	0	1	01	01	H3653_022_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3653	022	0	1	01	01	H3653_022_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3653	023	0	1	01	01	H3653_023_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3653	023	0	1	01	01	H3653_023_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3653	023	0	1	01	01	H3653_023_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3653	023	0	1	01	01	H3653_023_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3653	023	0	1	01	01	H3653_023_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3653	024	0	1	01	01	H3653_024_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3653	024	0	1	01	01	H3653_024_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3653	024	0	1	01	01	H3653_024_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3653	024	0	1	01	01	H3653_024_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3653	024	0	1	01	01	H3653_024_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3655	032	0	1	01	01	H3655_032_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3655	032	0	1	01	01	H3655_032_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3655	032	0	1	01	01	H3655_032_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3655	032	0	1	01	01	H3655_032_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3655	032	0	1	01	01	H3655_032_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3655	032	0	1	01	01	H3655_032_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3655	033	0	1	01	01	H3655_033_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3655	033	0	1	01	01	H3655_033_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3655	033	0	1	01	01	H3655_033_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3655	033	0	1	01	01	H3655_033_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3655	033	0	1	01	01	H3655_033_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3655	033	0	1	01	01	H3655_033_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3655	034	0	1	01	01	H3655_034_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3655	034	0	1	01	01	H3655_034_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3655	034	0	1	01	01	H3655_034_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3655	034	0	1	01	01	H3655_034_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3655	034	0	1	01	01	H3655_034_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3655	034	0	1	01	01	H3655_034_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3655	038	0	1	01	01	H3655_038_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3655	038	0	1	01	01	H3655_038_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3655	038	0	1	01	01	H3655_038_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3655	038	0	1	01	01	H3655_038_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3655	038	0	1	01	01	H3655_038_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3655	038	0	1	01	01	H3655_038_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3655	040	0	1	01	01	H3655_040_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3655	040	0	1	01	01	H3655_040_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3655	040	0	1	01	01	H3655_040_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3655	040	0	1	01	01	H3655_040_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3655	040	0	1	01	01	H3655_040_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3655	040	0	1	01	01	H3655_040_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3655	041	0	1	01	01	H3655_041_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3655	041	0	1	01	01	H3655_041_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3655	041	0	1	01	01	H3655_041_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3655	041	0	1	01	01	H3655_041_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3655	041	0	1	01	01	H3655_041_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3655	041	0	1	01	01	H3655_041_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3655	042	0	1	01	01	H3655_042_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3655	042	0	1	01	01	H3655_042_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3655	042	0	1	01	01	H3655_042_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3655	042	0	1	01	01	H3655_042_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3655	042	0	1	01	01	H3655_042_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3655	042	0	1	01	01	H3655_042_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3660	028	0	1	02	01	H3660_028_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3660	028	0	1	02	01	H3660_028_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3660	028	0	1	02	01	H3660_028_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	3						
H3660	028	0	1	02	01	H3660_028_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3660	028	0	1	02	01	H3660_028_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3660	028	0	1	02	01	H3660_028_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3660	029	0	1	02	01	H3660_029_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3660	029	0	1	02	01	H3660_029_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3660	029	0	1	02	01	H3660_029_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	3						
H3660	029	0	1	02	01	H3660_029_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3660	029	0	1	02	01	H3660_029_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3660	029	0	1	02	01	H3660_029_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3660	044	0	1	01	01	H3660_044_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3660	044	0	1	01	01	H3660_044_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3660	044	0	1	01	01	H3660_044_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	3						
H3660	044	0	1	01	01	H3660_044_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3660	044	0	1	01	01	H3660_044_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3660	044	0	1	01	01	H3660_044_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3660	047	0	1	01	01	H3660_047_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3660	047	0	1	01	01	H3660_047_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3660	047	0	1	01	01	H3660_047_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	3						
H3660	047	0	1	01	01	H3660_047_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3660	047	0	1	01	01	H3660_047_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3660	047	0	1	01	01	H3660_047_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3660	048	0	1	02	01	H3660_048_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3660	048	0	1	02	01	H3660_048_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3660	048	0	1	02	01	H3660_048_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	3						
H3660	048	0	1	02	01	H3660_048_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3660	048	0	1	02	01	H3660_048_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3660	048	0	1	02	01	H3660_048_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3660	050	0	1	01	01	H3660_050_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3660	050	0	1	01	01	H3660_050_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3660	050	0	1	01	01	H3660_050_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	3						
H3660	050	0	1	01	01	H3660_050_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3660	050	0	1	01	01	H3660_050_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3660	050	0	1	01	01	H3660_050_0	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3660	053	1	1	01	01	H3660_053_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3660	053	1	1	01	01	H3660_053_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3660	053	1	1	01	01	H3660_053_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	3						
H3660	053	1	1	01	01	H3660_053_1	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3660	053	1	1	01	01	H3660_053_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3660	053	1	1	01	01	H3660_053_1	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3660	053	2	1	01	01	H3660_053_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3660	053	2	1	01	01	H3660_053_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3660	053	2	1	01	01	H3660_053_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	3						
H3660	053	2	1	01	01	H3660_053_2	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3660	053	2	1	01	01	H3660_053_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3660	053	2	1	01	01	H3660_053_2	6	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3664	017	0	1	02	01	H3664_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3664	017	0	1	02	01	H3664_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3664	017	0	1	02	01	H3664_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3664	017	0	1	02	01	H3664_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3664	017	0	1	02	01	H3664_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3664	020	0	1	02	01	H3664_020_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3664	020	0	1	02	01	H3664_020_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3664	020	0	1	02	01	H3664_020_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3664	020	0	1	02	01	H3664_020_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3664	020	0	1	02	01	H3664_020_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3664	021	0	1	02	01	H3664_021_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3664	021	0	1	02	01	H3664_021_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3664	021	0	1	02	01	H3664_021_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3664	021	0	1	02	01	H3664_021_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3664	021	0	1	02	01	H3664_021_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	014	0	1	01	01	H3668_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	014	0	1	01	01	H3668_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3668	014	0	1	01	01	H3668_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	014	0	1	01	01	H3668_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	014	0	1	01	01	H3668_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	015	0	1	01	01	H3668_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	015	0	1	01	01	H3668_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3668	015	0	1	01	01	H3668_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	015	0	1	01	01	H3668_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	015	0	1	01	01	H3668_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	016	0	1	01	01	H3668_016_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	016	0	1	01	01	H3668_016_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	016	0	1	01	01	H3668_016_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	016	0	1	01	01	H3668_016_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	016	0	1	01	01	H3668_016_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	017	0	1	01	01	H3668_017_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	017	0	1	01	01	H3668_017_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	017	0	1	01	01	H3668_017_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	017	0	1	01	01	H3668_017_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	017	0	1	01	01	H3668_017_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	018	1	1	01	01	H3668_018_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	018	1	1	01	01	H3668_018_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	018	1	1	01	01	H3668_018_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	018	1	1	01	01	H3668_018_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	018	1	1	01	01	H3668_018_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	018	2	1	01	01	H3668_018_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	018	2	1	01	01	H3668_018_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	018	2	1	01	01	H3668_018_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	018	2	1	01	01	H3668_018_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	018	2	1	01	01	H3668_018_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	018	3	1	01	01	H3668_018_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	018	3	1	01	01	H3668_018_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	018	3	1	01	01	H3668_018_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	018	3	1	01	01	H3668_018_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	018	3	1	01	01	H3668_018_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	019	1	1	01	01	H3668_019_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	019	1	1	01	01	H3668_019_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	019	1	1	01	01	H3668_019_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	019	1	1	01	01	H3668_019_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	019	1	1	01	01	H3668_019_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	019	2	1	01	01	H3668_019_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	019	2	1	01	01	H3668_019_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	019	2	1	01	01	H3668_019_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	019	2	1	01	01	H3668_019_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	019	2	1	01	01	H3668_019_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	019	3	1	01	01	H3668_019_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	019	3	1	01	01	H3668_019_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	019	3	1	01	01	H3668_019_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	019	3	1	01	01	H3668_019_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	019	3	1	01	01	H3668_019_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	020	0	1	01	01	H3668_020_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	020	0	1	01	01	H3668_020_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	020	0	1	01	01	H3668_020_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	020	0	1	01	01	H3668_020_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	020	0	1	01	01	H3668_020_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	021	0	1	01	01	H3668_021_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	021	0	1	01	01	H3668_021_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	021	0	1	01	01	H3668_021_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	021	0	1	01	01	H3668_021_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	021	0	1	01	01	H3668_021_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	022	0	1	01	01	H3668_022_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	022	0	1	01	01	H3668_022_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	022	0	1	01	01	H3668_022_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	022	0	1	01	01	H3668_022_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	022	0	1	01	01	H3668_022_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	023	0	1	01	01	H3668_023_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	023	0	1	01	01	H3668_023_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	023	0	1	01	01	H3668_023_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	023	0	1	01	01	H3668_023_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	023	0	1	01	01	H3668_023_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	024	0	1	01	01	H3668_024_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	024	0	1	01	01	H3668_024_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	024	0	1	01	01	H3668_024_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	024	0	1	01	01	H3668_024_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	024	0	1	01	01	H3668_024_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	025	0	1	01	01	H3668_025_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	025	0	1	01	01	H3668_025_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	025	0	1	01	01	H3668_025_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	025	0	1	01	01	H3668_025_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	025	0	1	01	01	H3668_025_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	026	0	1	01	01	H3668_026_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	026	0	1	01	01	H3668_026_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	026	0	1	01	01	H3668_026_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	026	0	1	01	01	H3668_026_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	026	0	1	01	01	H3668_026_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	027	0	1	01	01	H3668_027_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	027	0	1	01	01	H3668_027_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	027	0	1	01	01	H3668_027_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	027	0	1	01	01	H3668_027_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	027	0	1	01	01	H3668_027_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3668	028	0	1	01	01	H3668_028_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3668	028	0	1	01	01	H3668_028_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H3668	028	0	1	01	01	H3668_028_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3668	028	0	1	01	01	H3668_028_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3668	028	0	1	01	01	H3668_028_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3672	013	0	1	01	01	H3672_013_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3672	013	0	1	01	01	H3672_013_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3672	013	0	1	01	01	H3672_013_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3672	013	0	1	01	01	H3672_013_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3672	013	0	1	01	01	H3672_013_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3672	020	0	1	01	01	H3672_020_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3672	020	0	1	01	01	H3672_020_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3672	020	0	1	01	01	H3672_020_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3672	020	0	1	01	01	H3672_020_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3672	020	0	1	01	01	H3672_020_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3672	023	0	1	01	01	H3672_023_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3672	023	0	1	01	01	H3672_023_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3672	023	0	1	01	01	H3672_023_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3672	023	0	1	01	01	H3672_023_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3672	023	0	1	01	01	H3672_023_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3672	025	0	1	01	01	H3672_025_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3672	025	0	1	01	01	H3672_025_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3672	025	0	1	01	01	H3672_025_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3672	025	0	1	01	01	H3672_025_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3672	025	0	1	01	01	H3672_025_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3706	001	0	1	01	01	H3706_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3706	001	0	1	01	01	H3706_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3706	001	0	1	01	01	H3706_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3706	001	0	1	01	01	H3706_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3706	001	0	1	01	01	H3706_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3706	018	0	1	01	01	H3706_018_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3706	018	0	1	01	01	H3706_018_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3706	018	0	1	01	01	H3706_018_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3706	018	0	1	01	01	H3706_018_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3706	018	0	1	01	01	H3706_018_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3706	021	0	1	02	01	H3706_021_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3706	021	0	1	02	01	H3706_021_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3706	021	0	1	02	01	H3706_021_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3706	021	0	1	02	01	H3706_021_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3706	021	0	1	02	01	H3706_021_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3725	001	0	1	04	01	H3725_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3725	001	0	1	04	01	H3725_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3725	001	0	1	04	01	H3725_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3725	001	0	1	04	01	H3725_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3725	001	0	1	04	01	H3725_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3725	001	0	1	04	01	H3725_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H3725	004	0	1	04	01	H3725_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3725	004	0	1	04	01	H3725_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3725	004	0	1	04	01	H3725_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3725	004	0	1	04	01	H3725_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3725	004	0	1	04	01	H3725_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3725	004	0	1	04	01	H3725_004_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H3727	001	1	1	01	01	H3727_001_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3727	001	1	1	01	01	H3727_001_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3727	001	1	1	01	01	H3727_001_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3727	001	1	1	01	01	H3727_001_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H3727	001	1	1	01	01	H3727_001_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H3727	001	2	1	01	01	H3727_001_2	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3727	001	2	1	01	01	H3727_001_2	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3727	001	2	1	01	01	H3727_001_2	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3727	001	2	1	01	01	H3727_001_2	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H3727	001	2	1	01	01	H3727_001_2	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H3727	001	3	1	01	01	H3727_001_3	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3727	001	3	1	01	01	H3727_001_3	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3727	001	3	1	01	01	H3727_001_3	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H3727	001	3	1	01	01	H3727_001_3	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H3727	001	3	1	01	01	H3727_001_3	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H3748	001	0	1	01	01	H3748_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3748	001	0	1	01	01	H3748_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3748	001	0	1	01	01	H3748_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3748	001	0	1	01	01	H3748_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3748	001	0	1	01	01	H3748_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3748	003	0	1	01	01	H3748_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3748	003	0	1	01	01	H3748_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3748	003	0	1	01	01	H3748_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3748	003	0	1	01	01	H3748_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3748	003	0	1	01	01	H3748_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3748	004	0	1	01	01	H3748_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3748	004	0	1	01	01	H3748_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3748	004	0	1	01	01	H3748_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3748	004	0	1	01	01	H3748_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3748	004	0	1	01	01	H3748_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3748	005	0	1	01	01	H3748_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3748	005	0	1	01	01	H3748_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3748	005	0	1	01	01	H3748_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3748	005	0	1	01	01	H3748_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3748	005	0	1	01	01	H3748_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3748	006	0	1	01	01	H3748_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3748	006	0	1	01	01	H3748_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3748	006	0	1	01	01	H3748_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3748	006	0	1	01	01	H3748_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3748	006	0	1	01	01	H3748_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3748	007	0	1	01	01	H3748_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3748	007	0	1	01	01	H3748_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3748	007	0	1	01	01	H3748_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3748	007	0	1	01	01	H3748_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3748	007	0	1	01	01	H3748_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3748	008	0	1	01	01	H3748_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3748	008	0	1	01	01	H3748_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3748	008	0	1	01	01	H3748_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3748	008	0	1	01	01	H3748_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3748	008	0	1	01	01	H3748_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3748	009	0	1	01	01	H3748_009_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3748	009	0	1	01	01	H3748_009_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3748	009	0	1	01	01	H3748_009_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3748	009	0	1	01	01	H3748_009_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3748	009	0	1	01	01	H3748_009_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3749	001	0	1	02	01	H3749_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3749	001	0	1	02	01	H3749_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3749	001	0	1	02	01	H3749_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3749	001	0	1	02	01	H3749_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3749	001	0	1	02	01	H3749_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3749	017	0	1	02	01	H3749_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3749	017	0	1	02	01	H3749_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3749	017	0	1	02	01	H3749_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3749	017	0	1	02	01	H3749_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3749	017	0	1	02	01	H3749_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3749	018	0	1	02	01	H3749_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3749	018	0	1	02	01	H3749_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3749	018	0	1	02	01	H3749_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3749	018	0	1	02	01	H3749_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3749	018	0	1	02	01	H3749_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3749	020	0	1	02	01	H3749_020_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3749	020	0	1	02	01	H3749_020_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3749	020	0	1	02	01	H3749_020_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3749	020	0	1	02	01	H3749_020_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3749	020	0	1	02	01	H3749_020_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3755	001	0	1	01	01	H3755_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3755	001	0	1	01	01	H3755_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3755	001	0	1	01	01	H3755_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3755	001	0	1	01	01	H3755_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3755	001	0	1	01	01	H3755_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3755	004	0	1	01	01	H3755_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3755	004	0	1	01	01	H3755_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3755	004	0	1	01	01	H3755_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3755	004	0	1	01	01	H3755_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3755	004	0	1	01	01	H3755_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3755	005	0	1	01	01	H3755_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3755	005	0	1	01	01	H3755_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3755	005	0	1	01	01	H3755_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3755	005	0	1	01	01	H3755_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3755	005	0	1	01	01	H3755_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3777	001	2	1	01	01	H3777_001_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3777	001	2	1	01	01	H3777_001_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3777	001	2	1	01	01	H3777_001_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3777	001	2	1	01	01	H3777_001_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3777	001	2	1	01	01	H3777_001_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3777	001	2	1	01	01	H3777_001_2	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3777	001	3	1	01	01	H3777_001_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3777	001	3	1	01	01	H3777_001_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3777	001	3	1	01	01	H3777_001_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3777	001	3	1	01	01	H3777_001_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3777	001	3	1	01	01	H3777_001_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3777	001	3	1	01	01	H3777_001_3	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3777	001	4	1	01	01	H3777_001_4	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3777	001	4	1	01	01	H3777_001_4	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3777	001	4	1	01	01	H3777_001_4	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3777	001	4	1	01	01	H3777_001_4	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3777	001	4	1	01	01	H3777_001_4	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3777	001	4	1	01	01	H3777_001_4	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3805	001	0	1	01	01	H3805_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	001	0	1	01	01	H3805_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	001	0	1	01	01	H3805_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	001	0	1	01	01	H3805_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	001	0	1	01	01	H3805_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	007	0	1	01	01	H3805_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	007	0	1	01	01	H3805_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	007	0	1	01	01	H3805_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	007	0	1	01	01	H3805_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	007	0	1	01	01	H3805_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	015	0	1	01	01	H3805_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	015	0	1	01	01	H3805_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	015	0	1	01	01	H3805_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	015	0	1	01	01	H3805_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	015	0	1	01	01	H3805_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	016	0	1	01	01	H3805_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	016	0	1	01	01	H3805_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	016	0	1	01	01	H3805_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	016	0	1	01	01	H3805_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	016	0	1	01	01	H3805_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	017	0	1	01	01	H3805_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	017	0	1	01	01	H3805_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	017	0	1	01	01	H3805_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	017	0	1	01	01	H3805_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	017	0	1	01	01	H3805_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	019	0	1	01	01	H3805_019_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	019	0	1	01	01	H3805_019_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	019	0	1	01	01	H3805_019_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	019	0	1	01	01	H3805_019_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	019	0	1	01	01	H3805_019_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	020	0	1	01	01	H3805_020_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	020	0	1	01	01	H3805_020_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	020	0	1	01	01	H3805_020_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	020	0	1	01	01	H3805_020_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	020	0	1	01	01	H3805_020_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	021	0	1	01	01	H3805_021_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	021	0	1	01	01	H3805_021_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	021	0	1	01	01	H3805_021_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	021	0	1	01	01	H3805_021_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	021	0	1	01	01	H3805_021_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	023	1	1	01	01	H3805_023_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	023	1	1	01	01	H3805_023_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	023	1	1	01	01	H3805_023_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	023	1	1	01	01	H3805_023_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	023	1	1	01	01	H3805_023_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	023	2	1	01	01	H3805_023_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	023	2	1	01	01	H3805_023_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	023	2	1	01	01	H3805_023_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	023	2	1	01	01	H3805_023_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	023	2	1	01	01	H3805_023_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	025	1	1	01	01	H3805_025_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	025	1	1	01	01	H3805_025_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	025	1	1	01	01	H3805_025_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	025	1	1	01	01	H3805_025_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	025	1	1	01	01	H3805_025_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	025	2	1	01	01	H3805_025_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	025	2	1	01	01	H3805_025_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	025	2	1	01	01	H3805_025_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	025	2	1	01	01	H3805_025_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	025	2	1	01	01	H3805_025_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	029	0	1	01	01	H3805_029_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	029	0	1	01	01	H3805_029_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	029	0	1	01	01	H3805_029_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	029	0	1	01	01	H3805_029_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	029	0	1	01	01	H3805_029_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	030	0	1	01	01	H3805_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	030	0	1	01	01	H3805_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	030	0	1	01	01	H3805_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	030	0	1	01	01	H3805_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	030	0	1	01	01	H3805_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	032	0	1	02	01	H3805_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	032	0	1	02	01	H3805_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	032	0	1	02	01	H3805_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	032	0	1	02	01	H3805_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	032	0	1	02	01	H3805_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	033	0	1	02	01	H3805_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	033	0	1	02	01	H3805_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	033	0	1	02	01	H3805_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	033	0	1	02	01	H3805_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	033	0	1	02	01	H3805_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	034	0	1	02	01	H3805_034_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	034	0	1	02	01	H3805_034_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	034	0	1	02	01	H3805_034_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	034	0	1	02	01	H3805_034_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	034	0	1	02	01	H3805_034_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	036	0	1	01	01	H3805_036_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	036	0	1	01	01	H3805_036_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	036	0	1	01	01	H3805_036_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	036	0	1	01	01	H3805_036_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	036	0	1	01	01	H3805_036_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3805	037	0	1	01	01	H3805_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3805	037	0	1	01	01	H3805_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3805	037	0	1	01	01	H3805_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3805	037	0	1	01	01	H3805_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3805	037	0	1	01	01	H3805_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3810	003	0	1	01	01	H3810_003_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	3						
H3810	003	0	1	01	01	H3810_003_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H3810	003	0	1	01	01	H3810_003_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H3810	003	0	1	01	01	H3810_003_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H3810	003	0	1	01	01	H3810_003_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H3810	003	0	1	01	01	H3810_003_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H3810	022	0	1	01	01	H3810_022_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	3						
H3810	022	0	1	01	01	H3810_022_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H3810	022	0	1	01	01	H3810_022_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H3810	022	0	1	01	01	H3810_022_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H3810	022	0	1	01	01	H3810_022_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H3810	022	0	1	01	01	H3810_022_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H3811	002	0	1	01	01	H3811_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3811	002	0	1	01	01	H3811_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3811	002	0	1	01	01	H3811_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3811	002	0	1	01	01	H3811_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3811	002	0	1	01	01	H3811_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3811	002	0	1	01	01	H3811_002_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3811	009	0	1	01	01	H3811_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3811	009	0	1	01	01	H3811_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H3811	009	0	1	01	01	H3811_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3811	009	0	1	01	01	H3811_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3811	009	0	1	01	01	H3811_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3811	009	0	1	01	01	H3811_009_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H3813	009	0	1	04	01	H3813_009_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3813	009	0	1	04	01	H3813_009_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3813	009	0	1	04	01	H3813_009_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3813	009	0	1	04	01	H3813_009_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3813	009	0	1	04	01	H3813_009_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3813	009	0	1	04	01	H3813_009_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H3813	010	0	1	04	01	H3813_010_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3813	010	0	1	04	01	H3813_010_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3813	010	0	1	04	01	H3813_010_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3813	010	0	1	04	01	H3813_010_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3813	010	0	1	04	01	H3813_010_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3813	010	0	1	04	01	H3813_010_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H3813	011	0	1	04	01	H3813_011_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3813	011	0	1	04	01	H3813_011_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3813	011	0	1	04	01	H3813_011_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3813	011	0	1	04	01	H3813_011_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3813	011	0	1	04	01	H3813_011_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3813	011	0	1	04	01	H3813_011_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H3813	012	0	1	04	01	H3813_012_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3813	012	0	1	04	01	H3813_012_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3813	012	0	1	04	01	H3813_012_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3813	012	0	1	04	01	H3813_012_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3813	012	0	1	04	01	H3813_012_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3813	012	0	1	04	01	H3813_012_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H3813	013	0	1	04	01	H3813_013_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3813	013	0	1	04	01	H3813_013_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3813	013	0	1	04	01	H3813_013_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3813	013	0	1	04	01	H3813_013_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3813	013	0	1	04	01	H3813_013_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3813	013	0	1	04	01	H3813_013_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H3813	014	0	1	04	01	H3813_014_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3813	014	0	1	04	01	H3813_014_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3813	014	0	1	04	01	H3813_014_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3813	014	0	1	04	01	H3813_014_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	10	1						
H3813	014	0	1	04	01	H3813_014_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3813	014	0	1	04	01	H3813_014_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H3815	001	0	1	01	01	H3815_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	001	0	1	01	01	H3815_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	001	0	1	01	01	H3815_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	001	0	1	01	01	H3815_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	001	0	1	01	01	H3815_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	001	0	1	01	01	H3815_001_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	006	0	1	01	01	H3815_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	006	0	1	01	01	H3815_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	006	0	1	01	01	H3815_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	006	0	1	01	01	H3815_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	006	0	1	01	01	H3815_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	006	0	1	01	01	H3815_006_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	007	0	1	01	01	H3815_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	007	0	1	01	01	H3815_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	007	0	1	01	01	H3815_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	007	0	1	01	01	H3815_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	007	0	1	01	01	H3815_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	007	0	1	01	01	H3815_007_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	008	0	1	01	01	H3815_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	008	0	1	01	01	H3815_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	008	0	1	01	01	H3815_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	008	0	1	01	01	H3815_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	008	0	1	01	01	H3815_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	008	0	1	01	01	H3815_008_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	009	0	1	01	01	H3815_009_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	009	0	1	01	01	H3815_009_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	009	0	1	01	01	H3815_009_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	009	0	1	01	01	H3815_009_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	009	0	1	01	01	H3815_009_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	009	0	1	01	01	H3815_009_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	010	0	1	01	01	H3815_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	010	0	1	01	01	H3815_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	010	0	1	01	01	H3815_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	010	0	1	01	01	H3815_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	010	0	1	01	01	H3815_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	010	0	1	01	01	H3815_010_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	011	0	1	01	01	H3815_011_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	011	0	1	01	01	H3815_011_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	011	0	1	01	01	H3815_011_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	011	0	1	01	01	H3815_011_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	011	0	1	01	01	H3815_011_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	011	0	1	01	01	H3815_011_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	013	0	1	01	01	H3815_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	013	0	1	01	01	H3815_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	013	0	1	01	01	H3815_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	013	0	1	01	01	H3815_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	013	0	1	01	01	H3815_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	013	0	1	01	01	H3815_013_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	015	0	1	01	01	H3815_015_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	015	0	1	01	01	H3815_015_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	015	0	1	01	01	H3815_015_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	015	0	1	01	01	H3815_015_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	015	0	1	01	01	H3815_015_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	015	0	1	01	01	H3815_015_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	016	0	1	01	01	H3815_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	016	0	1	01	01	H3815_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	016	0	1	01	01	H3815_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	016	0	1	01	01	H3815_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	016	0	1	01	01	H3815_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	016	0	1	01	01	H3815_016_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	018	0	1	01	01	H3815_018_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	018	0	1	01	01	H3815_018_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	018	0	1	01	01	H3815_018_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	018	0	1	01	01	H3815_018_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	018	0	1	01	01	H3815_018_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	018	0	1	01	01	H3815_018_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	019	0	1	01	01	H3815_019_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	019	0	1	01	01	H3815_019_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	019	0	1	01	01	H3815_019_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	019	0	1	01	01	H3815_019_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	019	0	1	01	01	H3815_019_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	019	0	1	01	01	H3815_019_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	020	0	1	01	01	H3815_020_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	020	0	1	01	01	H3815_020_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	020	0	1	01	01	H3815_020_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	020	0	1	01	01	H3815_020_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	020	0	1	01	01	H3815_020_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	020	0	1	01	01	H3815_020_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	021	0	1	01	01	H3815_021_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	021	0	1	01	01	H3815_021_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	021	0	1	01	01	H3815_021_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	021	0	1	01	01	H3815_021_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	021	0	1	01	01	H3815_021_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	021	0	1	01	01	H3815_021_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	022	0	1	01	01	H3815_022_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	022	0	1	01	01	H3815_022_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	022	0	1	01	01	H3815_022_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	022	0	1	01	01	H3815_022_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	022	0	1	01	01	H3815_022_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	022	0	1	01	01	H3815_022_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	023	0	1	01	01	H3815_023_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	023	0	1	01	01	H3815_023_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	023	0	1	01	01	H3815_023_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	023	0	1	01	01	H3815_023_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	023	0	1	01	01	H3815_023_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	023	0	1	01	01	H3815_023_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	024	0	1	01	01	H3815_024_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	024	0	1	01	01	H3815_024_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	024	0	1	01	01	H3815_024_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	024	0	1	01	01	H3815_024_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	024	0	1	01	01	H3815_024_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	024	0	1	01	01	H3815_024_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	025	0	1	01	01	H3815_025_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	025	0	1	01	01	H3815_025_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	025	0	1	01	01	H3815_025_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	025	0	1	01	01	H3815_025_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	025	0	1	01	01	H3815_025_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	025	0	1	01	01	H3815_025_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	026	0	1	01	01	H3815_026_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	026	0	1	01	01	H3815_026_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	026	0	1	01	01	H3815_026_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	026	0	1	01	01	H3815_026_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	026	0	1	01	01	H3815_026_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	026	0	1	01	01	H3815_026_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	027	0	1	01	01	H3815_027_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	027	0	1	01	01	H3815_027_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	027	0	1	01	01	H3815_027_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	027	0	1	01	01	H3815_027_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	027	0	1	01	01	H3815_027_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	027	0	1	01	01	H3815_027_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	028	0	1	01	01	H3815_028_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	028	0	1	01	01	H3815_028_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	028	0	1	01	01	H3815_028_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	028	0	1	01	01	H3815_028_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	028	0	1	01	01	H3815_028_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	028	0	1	01	01	H3815_028_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	029	0	1	01	01	H3815_029_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	029	0	1	01	01	H3815_029_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	029	0	1	01	01	H3815_029_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	029	0	1	01	01	H3815_029_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	029	0	1	01	01	H3815_029_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	029	0	1	01	01	H3815_029_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	030	0	1	01	01	H3815_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	030	0	1	01	01	H3815_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	030	0	1	01	01	H3815_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	030	0	1	01	01	H3815_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	030	0	1	01	01	H3815_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	030	0	1	01	01	H3815_030_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	031	0	1	01	01	H3815_031_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	031	0	1	01	01	H3815_031_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	031	0	1	01	01	H3815_031_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	031	0	1	01	01	H3815_031_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	031	0	1	01	01	H3815_031_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	031	0	1	01	01	H3815_031_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3815	032	0	1	01	01	H3815_032_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H3815	032	0	1	01	01	H3815_032_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H3815	032	0	1	01	01	H3815_032_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H3815	032	0	1	01	01	H3815_032_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H3815	032	0	1	01	01	H3815_032_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3815	032	0	1	01	01	H3815_032_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3817	008	1	1	04	01	H3817_008_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3817	008	1	1	04	01	H3817_008_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3817	008	1	1	04	01	H3817_008_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3817	008	1	1	04	01	H3817_008_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3817	008	1	1	04	01	H3817_008_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3817	008	2	1	04	01	H3817_008_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3817	008	2	1	04	01	H3817_008_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3817	008	2	1	04	01	H3817_008_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3817	008	2	1	04	01	H3817_008_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3817	008	2	1	04	01	H3817_008_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3817	009	1	1	04	01	H3817_009_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3817	009	1	1	04	01	H3817_009_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3817	009	1	1	04	01	H3817_009_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3817	009	1	1	04	01	H3817_009_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3817	009	1	1	04	01	H3817_009_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3817	009	2	1	04	01	H3817_009_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3817	009	2	1	04	01	H3817_009_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3817	009	2	1	04	01	H3817_009_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3817	009	2	1	04	01	H3817_009_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3817	009	2	1	04	01	H3817_009_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3817	011	1	1	04	01	H3817_011_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3817	011	1	1	04	01	H3817_011_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3817	011	1	1	04	01	H3817_011_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3817	011	1	1	04	01	H3817_011_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3817	011	1	1	04	01	H3817_011_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3817	011	2	1	04	01	H3817_011_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3817	011	2	1	04	01	H3817_011_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3817	011	2	1	04	01	H3817_011_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3817	011	2	1	04	01	H3817_011_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3817	011	2	1	04	01	H3817_011_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3822	001	0	1	01	01	H3822_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3822	001	0	1	01	01	H3822_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3822	001	0	1	01	01	H3822_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3822	001	0	1	01	01	H3822_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3822	001	0	1	01	01	H3822_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3822	002	0	1	01	01	H3822_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3822	002	0	1	01	01	H3822_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3822	002	0	1	01	01	H3822_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3822	002	0	1	01	01	H3822_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3822	002	0	1	01	01	H3822_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3822	007	0	1	02	01	H3822_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3822	007	0	1	02	01	H3822_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3822	007	0	1	02	01	H3822_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3822	007	0	1	02	01	H3822_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3822	007	0	1	02	01	H3822_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3822	008	0	1	02	01	H3822_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3822	008	0	1	02	01	H3822_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3822	008	0	1	02	01	H3822_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3822	008	0	1	02	01	H3822_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3822	008	0	1	02	01	H3822_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3822	012	0	1	01	01	H3822_012_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3822	012	0	1	01	01	H3822_012_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3822	012	0	1	01	01	H3822_012_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3822	012	0	1	01	01	H3822_012_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3822	012	0	1	01	01	H3822_012_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3832	007	0	1	04	01	H3832_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3832	007	0	1	04	01	H3832_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3832	007	0	1	04	01	H3832_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3832	007	0	1	04	01	H3832_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3832	007	0	1	04	01	H3832_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3832	008	0	1	04	01	H3832_008_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3832	008	0	1	04	01	H3832_008_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3832	008	0	1	04	01	H3832_008_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3832	008	0	1	04	01	H3832_008_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3832	008	0	1	04	01	H3832_008_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3832	009	0	1	04	01	H3832_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3832	009	0	1	04	01	H3832_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3832	009	0	1	04	01	H3832_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3832	009	0	1	04	01	H3832_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3832	009	0	1	04	01	H3832_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3832	010	0	1	04	01	H3832_010_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3832	010	0	1	04	01	H3832_010_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3832	010	0	1	04	01	H3832_010_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3832	010	0	1	04	01	H3832_010_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3832	010	0	1	04	01	H3832_010_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3864	006	0	1	01	01	H3864_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	006	0	1	01	01	H3864_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	006	0	1	01	01	H3864_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	006	0	1	01	01	H3864_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	006	0	1	01	01	H3864_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	006	0	1	01	01	H3864_006_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	014	0	1	02	01	H3864_014_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	014	0	1	02	01	H3864_014_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	014	0	1	02	01	H3864_014_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	014	0	1	02	01	H3864_014_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	014	0	1	02	01	H3864_014_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	014	0	1	02	01	H3864_014_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	021	0	1	01	01	H3864_021_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	021	0	1	01	01	H3864_021_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	021	0	1	01	01	H3864_021_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	021	0	1	01	01	H3864_021_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	021	0	1	01	01	H3864_021_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	021	0	1	01	01	H3864_021_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	024	0	1	02	01	H3864_024_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	024	0	1	02	01	H3864_024_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	024	0	1	02	01	H3864_024_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	024	0	1	02	01	H3864_024_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	024	0	1	02	01	H3864_024_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	024	0	1	02	01	H3864_024_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	027	0	1	01	01	H3864_027_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	027	0	1	01	01	H3864_027_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	027	0	1	01	01	H3864_027_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	027	0	1	01	01	H3864_027_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	027	0	1	01	01	H3864_027_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	027	0	1	01	01	H3864_027_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	029	0	1	02	01	H3864_029_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	029	0	1	02	01	H3864_029_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	029	0	1	02	01	H3864_029_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	029	0	1	02	01	H3864_029_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	029	0	1	02	01	H3864_029_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	029	0	1	02	01	H3864_029_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	032	0	1	01	01	H3864_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	032	0	1	01	01	H3864_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	032	0	1	01	01	H3864_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	032	0	1	01	01	H3864_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	032	0	1	01	01	H3864_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	032	0	1	01	01	H3864_032_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	033	0	1	01	01	H3864_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	033	0	1	01	01	H3864_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	033	0	1	01	01	H3864_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	033	0	1	01	01	H3864_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	033	0	1	01	01	H3864_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	033	0	1	01	01	H3864_033_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	034	0	1	01	01	H3864_034_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	034	0	1	01	01	H3864_034_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	034	0	1	01	01	H3864_034_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	034	0	1	01	01	H3864_034_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	034	0	1	01	01	H3864_034_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	034	0	1	01	01	H3864_034_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	036	0	1	01	01	H3864_036_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	036	0	1	01	01	H3864_036_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	036	0	1	01	01	H3864_036_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	036	0	1	01	01	H3864_036_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	036	0	1	01	01	H3864_036_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	036	0	1	01	01	H3864_036_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	037	0	1	01	01	H3864_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	037	0	1	01	01	H3864_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	037	0	1	01	01	H3864_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	037	0	1	01	01	H3864_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	037	0	1	01	01	H3864_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	037	0	1	01	01	H3864_037_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	038	0	1	01	01	H3864_038_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	038	0	1	01	01	H3864_038_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	038	0	1	01	01	H3864_038_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	038	0	1	01	01	H3864_038_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	038	0	1	01	01	H3864_038_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	038	0	1	01	01	H3864_038_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	039	0	1	01	01	H3864_039_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	039	0	1	01	01	H3864_039_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	039	0	1	01	01	H3864_039_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	039	0	1	01	01	H3864_039_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	039	0	1	01	01	H3864_039_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	039	0	1	01	01	H3864_039_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	040	0	1	01	01	H3864_040_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	040	0	1	01	01	H3864_040_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	040	0	1	01	01	H3864_040_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	040	0	1	01	01	H3864_040_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	040	0	1	01	01	H3864_040_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	040	0	1	01	01	H3864_040_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3864	041	0	1	01	01	H3864_041_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3864	041	0	1	01	01	H3864_041_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3864	041	0	1	01	01	H3864_041_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3864	041	0	1	01	01	H3864_041_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3864	041	0	1	01	01	H3864_041_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3864	041	0	1	01	01	H3864_041_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3890	001	0	1	04	01	H3890_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3890	001	0	1	04	01	H3890_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3890	001	0	1	04	01	H3890_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3890	001	0	1	04	01	H3890_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3890	001	0	1	04	01	H3890_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3890	002	0	1	04	01	H3890_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3890	002	0	1	04	01	H3890_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3890	002	0	1	04	01	H3890_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3890	002	0	1	04	01	H3890_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3890	002	0	1	04	01	H3890_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3890	004	0	1	04	01	H3890_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3890	004	0	1	04	01	H3890_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3890	004	0	1	04	01	H3890_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3890	004	0	1	04	01	H3890_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3890	004	0	1	04	01	H3890_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	006	0	1	01	01	H3907_006_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3907	006	0	1	01	01	H3907_006_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	006	0	1	01	01	H3907_006_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	006	0	1	01	01	H3907_006_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	006	0	1	01	01	H3907_006_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	029	0	1	01	01	H3907_029_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H3907	029	0	1	01	01	H3907_029_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	029	0	1	01	01	H3907_029_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	029	0	1	01	01	H3907_029_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	029	0	1	01	01	H3907_029_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	037	0	1	01	01	H3907_037_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3907	037	0	1	01	01	H3907_037_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	037	0	1	01	01	H3907_037_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	037	0	1	01	01	H3907_037_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	037	0	1	01	01	H3907_037_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	045	0	1	01	01	H3907_045_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3907	045	0	1	01	01	H3907_045_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	045	0	1	01	01	H3907_045_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	045	0	1	01	01	H3907_045_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	045	0	1	01	01	H3907_045_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	046	0	1	01	01	H3907_046_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3907	046	0	1	01	01	H3907_046_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	046	0	1	01	01	H3907_046_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	046	0	1	01	01	H3907_046_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	046	0	1	01	01	H3907_046_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	047	0	1	01	01	H3907_047_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3907	047	0	1	01	01	H3907_047_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	047	0	1	01	01	H3907_047_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	047	0	1	01	01	H3907_047_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	047	0	1	01	01	H3907_047_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	049	0	1	01	01	H3907_049_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3907	049	0	1	01	01	H3907_049_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	049	0	1	01	01	H3907_049_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	049	0	1	01	01	H3907_049_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	049	0	1	01	01	H3907_049_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	050	0	1	01	01	H3907_050_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3907	050	0	1	01	01	H3907_050_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	050	0	1	01	01	H3907_050_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	050	0	1	01	01	H3907_050_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	050	0	1	01	01	H3907_050_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	051	0	1	01	01	H3907_051_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3907	051	0	1	01	01	H3907_051_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	051	0	1	01	01	H3907_051_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	051	0	1	01	01	H3907_051_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	051	0	1	01	01	H3907_051_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3907	052	0	1	01	01	H3907_052_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3907	052	0	1	01	01	H3907_052_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3907	052	0	1	01	01	H3907_052_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3907	052	0	1	01	01	H3907_052_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3907	052	0	1	01	01	H3907_052_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3909	001	0	1	04	01	H3909_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3909	001	0	1	04	01	H3909_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3909	001	0	1	04	01	H3909_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3909	001	0	1	04	01	H3909_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3909	001	0	1	04	01	H3909_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3909	009	0	1	04	01	H3909_009_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3909	009	0	1	04	01	H3909_009_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3909	009	0	1	04	01	H3909_009_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3909	009	0	1	04	01	H3909_009_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3909	009	0	1	04	01	H3909_009_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3909	014	0	1	04	01	H3909_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3909	014	0	1	04	01	H3909_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3909	014	0	1	04	01	H3909_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3909	014	0	1	04	01	H3909_014_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3909	014	0	1	04	01	H3909_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3909	015	0	1	04	01	H3909_015_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3909	015	0	1	04	01	H3909_015_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3909	015	0	1	04	01	H3909_015_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3909	015	0	1	04	01	H3909_015_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3909	015	0	1	04	01	H3909_015_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	001	0	1	04	01	H3916_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	001	0	1	04	01	H3916_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	001	0	1	04	01	H3916_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	001	0	1	04	01	H3916_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	001	0	1	04	01	H3916_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	002	0	1	04	01	H3916_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	002	0	1	04	01	H3916_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	002	0	1	04	01	H3916_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	002	0	1	04	01	H3916_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	002	0	1	04	01	H3916_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	005	0	1	04	01	H3916_005_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	005	0	1	04	01	H3916_005_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	005	0	1	04	01	H3916_005_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	005	0	1	04	01	H3916_005_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	005	0	1	04	01	H3916_005_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	015	0	1	04	01	H3916_015_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	015	0	1	04	01	H3916_015_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	015	0	1	04	01	H3916_015_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	015	0	1	04	01	H3916_015_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	015	0	1	04	01	H3916_015_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	018	0	1	04	01	H3916_018_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	018	0	1	04	01	H3916_018_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	018	0	1	04	01	H3916_018_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	018	0	1	04	01	H3916_018_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	018	0	1	04	01	H3916_018_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	022	0	1	04	01	H3916_022_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	022	0	1	04	01	H3916_022_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	022	0	1	04	01	H3916_022_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	022	0	1	04	01	H3916_022_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	022	0	1	04	01	H3916_022_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	024	0	1	04	01	H3916_024_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	024	0	1	04	01	H3916_024_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	024	0	1	04	01	H3916_024_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	024	0	1	04	01	H3916_024_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	024	0	1	04	01	H3916_024_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	032	0	1	04	01	H3916_032_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	032	0	1	04	01	H3916_032_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	032	0	1	04	01	H3916_032_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	032	0	1	04	01	H3916_032_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	032	0	1	04	01	H3916_032_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	033	0	1	04	01	H3916_033_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	033	0	1	04	01	H3916_033_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	033	0	1	04	01	H3916_033_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	033	0	1	04	01	H3916_033_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	033	0	1	04	01	H3916_033_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	034	1	1	04	01	H3916_034_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	034	1	1	04	01	H3916_034_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	034	1	1	04	01	H3916_034_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	034	1	1	04	01	H3916_034_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	034	1	1	04	01	H3916_034_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	034	3	1	04	01	H3916_034_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	034	3	1	04	01	H3916_034_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	034	3	1	04	01	H3916_034_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	034	3	1	04	01	H3916_034_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	034	3	1	04	01	H3916_034_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	034	4	1	04	01	H3916_034_4	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	034	4	1	04	01	H3916_034_4	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	034	4	1	04	01	H3916_034_4	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	034	4	1	04	01	H3916_034_4	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	034	4	1	04	01	H3916_034_4	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	034	5	1	04	01	H3916_034_5	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	034	5	1	04	01	H3916_034_5	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	034	5	1	04	01	H3916_034_5	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	034	5	1	04	01	H3916_034_5	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	034	5	1	04	01	H3916_034_5	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	035	1	1	04	01	H3916_035_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	035	1	1	04	01	H3916_035_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	035	1	1	04	01	H3916_035_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	035	1	1	04	01	H3916_035_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	035	1	1	04	01	H3916_035_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	035	2	1	04	01	H3916_035_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	035	2	1	04	01	H3916_035_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	035	2	1	04	01	H3916_035_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	035	2	1	04	01	H3916_035_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	035	2	1	04	01	H3916_035_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	036	0	1	04	01	H3916_036_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	036	0	1	04	01	H3916_036_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	036	0	1	04	01	H3916_036_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	036	0	1	04	01	H3916_036_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	036	0	1	04	01	H3916_036_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	037	1	1	04	01	H3916_037_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	037	1	1	04	01	H3916_037_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	037	1	1	04	01	H3916_037_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	037	1	1	04	01	H3916_037_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	037	1	1	04	01	H3916_037_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	037	2	1	04	01	H3916_037_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	037	2	1	04	01	H3916_037_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	037	2	1	04	01	H3916_037_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	037	2	1	04	01	H3916_037_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	037	2	1	04	01	H3916_037_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	037	3	1	04	01	H3916_037_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	037	3	1	04	01	H3916_037_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	037	3	1	04	01	H3916_037_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	037	3	1	04	01	H3916_037_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	037	3	1	04	01	H3916_037_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	037	4	1	04	01	H3916_037_4	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	037	4	1	04	01	H3916_037_4	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	037	4	1	04	01	H3916_037_4	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	037	4	1	04	01	H3916_037_4	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	037	4	1	04	01	H3916_037_4	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	038	0	1	04	01	H3916_038_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	038	0	1	04	01	H3916_038_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	038	0	1	04	01	H3916_038_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	038	0	1	04	01	H3916_038_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	038	0	1	04	01	H3916_038_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3916	039	0	1	04	01	H3916_039_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3916	039	0	1	04	01	H3916_039_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3916	039	0	1	04	01	H3916_039_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3916	039	0	1	04	01	H3916_039_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3916	039	0	1	04	01	H3916_039_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3923	013	0	1	04	01	H3923_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3923	013	0	1	04	01	H3923_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3923	013	0	1	04	01	H3923_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3923	013	0	1	04	01	H3923_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3923	013	0	1	04	01	H3923_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3923	013	0	1	04	01	H3923_013_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3923	017	0	1	04	01	H3923_017_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3923	017	0	1	04	01	H3923_017_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3923	017	0	1	04	01	H3923_017_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3923	017	0	1	04	01	H3923_017_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3923	017	0	1	04	01	H3923_017_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3923	017	0	1	04	01	H3923_017_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3923	028	0	1	04	01	H3923_028_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3923	028	0	1	04	01	H3923_028_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3923	028	0	1	04	01	H3923_028_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3923	028	0	1	04	01	H3923_028_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3923	028	0	1	04	01	H3923_028_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3923	028	0	1	04	01	H3923_028_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3924	059	13	1	04	01	H3924_059_13	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	059	13	1	04	01	H3924_059_13	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	059	13	1	04	01	H3924_059_13	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	059	13	1	04	01	H3924_059_13	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	059	13	1	04	01	H3924_059_13	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	059	13	1	04	01	H3924_059_13	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	059	14	1	04	01	H3924_059_14	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	059	14	1	04	01	H3924_059_14	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	059	14	1	04	01	H3924_059_14	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	059	14	1	04	01	H3924_059_14	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	059	14	1	04	01	H3924_059_14	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	059	14	1	04	01	H3924_059_14	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	059	15	1	04	01	H3924_059_15	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	059	15	1	04	01	H3924_059_15	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	059	15	1	04	01	H3924_059_15	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	059	15	1	04	01	H3924_059_15	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	059	15	1	04	01	H3924_059_15	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	059	15	1	04	01	H3924_059_15	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	059	16	1	04	01	H3924_059_16	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	059	16	1	04	01	H3924_059_16	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	059	16	1	04	01	H3924_059_16	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	059	16	1	04	01	H3924_059_16	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	059	16	1	04	01	H3924_059_16	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	059	16	1	04	01	H3924_059_16	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	059	17	1	04	01	H3924_059_17	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	059	17	1	04	01	H3924_059_17	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	059	17	1	04	01	H3924_059_17	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	059	17	1	04	01	H3924_059_17	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	059	17	1	04	01	H3924_059_17	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	059	17	1	04	01	H3924_059_17	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	059	18	1	04	01	H3924_059_18	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	059	18	1	04	01	H3924_059_18	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	059	18	1	04	01	H3924_059_18	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	059	18	1	04	01	H3924_059_18	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	059	18	1	04	01	H3924_059_18	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	059	18	1	04	01	H3924_059_18	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	060	13	1	04	01	H3924_060_13	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	060	13	1	04	01	H3924_060_13	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	060	13	1	04	01	H3924_060_13	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	060	13	1	04	01	H3924_060_13	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	060	13	1	04	01	H3924_060_13	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	060	13	1	04	01	H3924_060_13	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	060	14	1	04	01	H3924_060_14	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	060	14	1	04	01	H3924_060_14	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	060	14	1	04	01	H3924_060_14	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	060	14	1	04	01	H3924_060_14	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	060	14	1	04	01	H3924_060_14	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	060	14	1	04	01	H3924_060_14	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	060	15	1	04	01	H3924_060_15	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	060	15	1	04	01	H3924_060_15	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	060	15	1	04	01	H3924_060_15	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	060	15	1	04	01	H3924_060_15	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	060	15	1	04	01	H3924_060_15	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	060	15	1	04	01	H3924_060_15	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	060	16	1	04	01	H3924_060_16	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	060	16	1	04	01	H3924_060_16	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	060	16	1	04	01	H3924_060_16	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	060	16	1	04	01	H3924_060_16	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	060	16	1	04	01	H3924_060_16	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	060	16	1	04	01	H3924_060_16	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	060	17	1	04	01	H3924_060_17	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	060	17	1	04	01	H3924_060_17	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	060	17	1	04	01	H3924_060_17	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	060	17	1	04	01	H3924_060_17	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	060	17	1	04	01	H3924_060_17	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	060	17	1	04	01	H3924_060_17	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	060	18	1	04	01	H3924_060_18	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	060	18	1	04	01	H3924_060_18	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	060	18	1	04	01	H3924_060_18	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	060	18	1	04	01	H3924_060_18	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	060	18	1	04	01	H3924_060_18	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	060	18	1	04	01	H3924_060_18	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	062	21	1	04	01	H3924_062_21	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	062	21	1	04	01	H3924_062_21	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	062	21	1	04	01	H3924_062_21	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	062	21	1	04	01	H3924_062_21	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	062	21	1	04	01	H3924_062_21	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	062	21	1	04	01	H3924_062_21	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	062	22	1	04	01	H3924_062_22	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	062	22	1	04	01	H3924_062_22	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	062	22	1	04	01	H3924_062_22	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	062	22	1	04	01	H3924_062_22	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	062	22	1	04	01	H3924_062_22	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	062	22	1	04	01	H3924_062_22	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	064	1	1	04	01	H3924_064_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	064	1	1	04	01	H3924_064_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	064	1	1	04	01	H3924_064_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	064	1	1	04	01	H3924_064_1	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	064	1	1	04	01	H3924_064_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	064	1	1	04	01	H3924_064_1	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3924	064	2	1	04	01	H3924_064_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3924	064	2	1	04	01	H3924_064_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3924	064	2	1	04	01	H3924_064_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3924	064	2	1	04	01	H3924_064_2	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3924	064	2	1	04	01	H3924_064_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3924	064	2	1	04	01	H3924_064_2	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3928	001	0	1	01	01	H3928_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3928	001	0	1	01	01	H3928_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3928	001	0	1	01	01	H3928_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3928	001	0	1	01	01	H3928_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3928	001	0	1	01	01	H3928_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3928	002	0	1	01	01	H3928_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3928	002	0	1	01	01	H3928_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3928	002	0	1	01	01	H3928_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3928	002	0	1	01	01	H3928_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3928	002	0	1	01	01	H3928_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	004	0	1	01	01	H3931_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3931	004	0	1	01	01	H3931_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3931	004	0	1	01	01	H3931_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	004	0	1	01	01	H3931_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	004	0	1	01	01	H3931_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	064	0	1	01	01	H3931_064_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	064	0	1	01	01	H3931_064_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	064	0	1	01	01	H3931_064_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	064	0	1	01	01	H3931_064_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	064	0	1	01	01	H3931_064_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	070	0	1	01	01	H3931_070_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	070	0	1	01	01	H3931_070_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	070	0	1	01	01	H3931_070_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	070	0	1	01	01	H3931_070_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	070	0	1	01	01	H3931_070_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	091	0	1	01	01	H3931_091_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	091	0	1	01	01	H3931_091_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	091	0	1	01	01	H3931_091_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	091	0	1	01	01	H3931_091_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	091	0	1	01	01	H3931_091_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	092	0	1	01	01	H3931_092_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	092	0	1	01	01	H3931_092_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	092	0	1	01	01	H3931_092_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	092	0	1	01	01	H3931_092_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	092	0	1	01	01	H3931_092_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	093	0	1	01	01	H3931_093_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	093	0	1	01	01	H3931_093_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	093	0	1	01	01	H3931_093_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	093	0	1	01	01	H3931_093_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	093	0	1	01	01	H3931_093_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	094	0	1	01	01	H3931_094_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	094	0	1	01	01	H3931_094_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	094	0	1	01	01	H3931_094_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	094	0	1	01	01	H3931_094_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	094	0	1	01	01	H3931_094_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	095	0	1	01	01	H3931_095_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	095	0	1	01	01	H3931_095_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	095	0	1	01	01	H3931_095_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	095	0	1	01	01	H3931_095_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	095	0	1	01	01	H3931_095_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	096	0	1	01	01	H3931_096_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	096	0	1	01	01	H3931_096_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	096	0	1	01	01	H3931_096_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	096	0	1	01	01	H3931_096_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	096	0	1	01	01	H3931_096_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	097	0	1	01	01	H3931_097_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	097	0	1	01	01	H3931_097_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	097	0	1	01	01	H3931_097_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	097	0	1	01	01	H3931_097_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	097	0	1	01	01	H3931_097_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	098	0	1	01	01	H3931_098_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	098	0	1	01	01	H3931_098_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	098	0	1	01	01	H3931_098_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	098	0	1	01	01	H3931_098_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	098	0	1	01	01	H3931_098_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	099	0	1	01	01	H3931_099_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	099	0	1	01	01	H3931_099_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	099	0	1	01	01	H3931_099_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	099	0	1	01	01	H3931_099_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	099	0	1	01	01	H3931_099_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	100	0	1	01	01	H3931_100_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	100	0	1	01	01	H3931_100_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	100	0	1	01	01	H3931_100_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	100	0	1	01	01	H3931_100_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	100	0	1	01	01	H3931_100_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	101	0	1	01	01	H3931_101_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	101	0	1	01	01	H3931_101_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	101	0	1	01	01	H3931_101_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	101	0	1	01	01	H3931_101_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	101	0	1	01	01	H3931_101_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	102	0	1	01	01	H3931_102_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3931	102	0	1	01	01	H3931_102_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3931	102	0	1	01	01	H3931_102_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	102	0	1	01	01	H3931_102_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	102	0	1	01	01	H3931_102_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	104	0	1	01	01	H3931_104_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	104	0	1	01	01	H3931_104_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	104	0	1	01	01	H3931_104_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	104	0	1	01	01	H3931_104_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	104	0	1	01	01	H3931_104_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	105	0	1	01	01	H3931_105_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	105	0	1	01	01	H3931_105_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	105	0	1	01	01	H3931_105_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	105	0	1	01	01	H3931_105_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	105	0	1	01	01	H3931_105_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	107	0	1	01	01	H3931_107_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	107	0	1	01	01	H3931_107_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	107	0	1	01	01	H3931_107_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	107	0	1	01	01	H3931_107_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	107	0	1	01	01	H3931_107_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	108	0	1	01	01	H3931_108_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	108	0	1	01	01	H3931_108_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	108	0	1	01	01	H3931_108_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	108	0	1	01	01	H3931_108_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	108	0	1	01	01	H3931_108_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	109	0	1	01	01	H3931_109_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	109	0	1	01	01	H3931_109_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	109	0	1	01	01	H3931_109_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	109	0	1	01	01	H3931_109_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	109	0	1	01	01	H3931_109_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	112	0	1	01	01	H3931_112_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	112	0	1	01	01	H3931_112_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	112	0	1	01	01	H3931_112_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	112	0	1	01	01	H3931_112_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	112	0	1	01	01	H3931_112_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	115	0	1	01	01	H3931_115_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	115	0	1	01	01	H3931_115_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	115	0	1	01	01	H3931_115_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	115	0	1	01	01	H3931_115_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	115	0	1	01	01	H3931_115_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	118	0	1	01	01	H3931_118_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	118	0	1	01	01	H3931_118_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	118	0	1	01	01	H3931_118_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	118	0	1	01	01	H3931_118_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	118	0	1	01	01	H3931_118_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	124	0	1	01	01	H3931_124_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	124	0	1	01	01	H3931_124_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	124	0	1	01	01	H3931_124_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	124	0	1	01	01	H3931_124_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	124	0	1	01	01	H3931_124_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	126	0	1	01	01	H3931_126_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	126	0	1	01	01	H3931_126_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	126	0	1	01	01	H3931_126_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	126	0	1	01	01	H3931_126_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	126	0	1	01	01	H3931_126_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	129	0	1	01	01	H3931_129_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	129	0	1	01	01	H3931_129_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	129	0	1	01	01	H3931_129_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	129	0	1	01	01	H3931_129_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	129	0	1	01	01	H3931_129_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	130	0	1	01	01	H3931_130_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	130	0	1	01	01	H3931_130_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	130	0	1	01	01	H3931_130_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	130	0	1	01	01	H3931_130_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	130	0	1	01	01	H3931_130_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	131	0	1	01	01	H3931_131_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	131	0	1	01	01	H3931_131_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	131	0	1	01	01	H3931_131_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	131	0	1	01	01	H3931_131_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	131	0	1	01	01	H3931_131_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	133	0	1	01	01	H3931_133_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	133	0	1	01	01	H3931_133_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	133	0	1	01	01	H3931_133_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	133	0	1	01	01	H3931_133_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	133	0	1	01	01	H3931_133_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	134	0	1	01	01	H3931_134_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	134	0	1	01	01	H3931_134_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	134	0	1	01	01	H3931_134_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	134	0	1	01	01	H3931_134_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	134	0	1	01	01	H3931_134_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3931	140	0	1	01	01	H3931_140_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3931	140	0	1	01	01	H3931_140_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3931	140	0	1	01	01	H3931_140_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3931	140	0	1	01	01	H3931_140_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3931	140	0	1	01	01	H3931_140_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3949	013	0	1	01	01	H3949_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3949	013	0	1	01	01	H3949_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3949	013	0	1	01	01	H3949_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3949	013	0	1	01	01	H3949_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3949	013	0	1	01	01	H3949_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3949	024	0	1	01	01	H3949_024_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H3949	024	0	1	01	01	H3949_024_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	01	1						
H3949	024	0	1	01	01	H3949_024_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	1						
H3949	024	0	1	01	01	H3949_024_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H3949	024	0	1	01	01	H3949_024_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H3949	024	0	1	01	01	H3949_024_0	6	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H3949	030	0	1	01	01	H3949_030_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3949	030	0	1	01	01	H3949_030_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3949	030	0	1	01	01	H3949_030_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3949	030	0	1	01	01	H3949_030_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3949	030	0	1	01	01	H3949_030_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3949	031	0	1	01	01	H3949_031_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3949	031	0	1	01	01	H3949_031_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3949	031	0	1	01	01	H3949_031_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3949	031	0	1	01	01	H3949_031_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3949	031	0	1	01	01	H3949_031_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3949	032	0	1	01	01	H3949_032_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3949	032	0	1	01	01	H3949_032_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3949	032	0	1	01	01	H3949_032_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3949	032	0	1	01	01	H3949_032_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3949	032	0	1	01	01	H3949_032_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3949	033	0	1	01	01	H3949_033_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3949	033	0	1	01	01	H3949_033_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3949	033	0	1	01	01	H3949_033_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3949	033	0	1	01	01	H3949_033_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3949	033	0	1	01	01	H3949_033_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3949	034	0	1	01	01	H3949_034_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3949	034	0	1	01	01	H3949_034_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3949	034	0	1	01	01	H3949_034_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3949	034	0	1	01	01	H3949_034_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3949	034	0	1	01	01	H3949_034_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3949	035	0	1	01	01	H3949_035_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3949	035	0	1	01	01	H3949_035_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3949	035	0	1	01	01	H3949_035_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3949	035	0	1	01	01	H3949_035_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3949	035	0	1	01	01	H3949_035_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3952	020	0	1	01	01	H3952_020_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3952	020	0	1	01	01	H3952_020_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3952	020	0	1	01	01	H3952_020_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3952	020	0	1	01	01	H3952_020_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3952	020	0	1	01	01	H3952_020_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3952	045	0	1	01	01	H3952_045_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3952	045	0	1	01	01	H3952_045_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3952	045	0	1	01	01	H3952_045_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3952	045	0	1	01	01	H3952_045_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3952	045	0	1	01	01	H3952_045_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3952	049	0	1	01	01	H3952_049_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3952	049	0	1	01	01	H3952_049_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3952	049	0	1	01	01	H3952_049_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3952	049	0	1	01	01	H3952_049_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3952	049	0	1	01	01	H3952_049_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3952	051	0	1	01	01	H3952_051_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3952	051	0	1	01	01	H3952_051_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3952	051	0	1	01	01	H3952_051_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3952	051	0	1	01	01	H3952_051_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3952	051	0	1	01	01	H3952_051_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3952	053	0	1	02	01	H3952_053_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3952	053	0	1	02	01	H3952_053_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3952	053	0	1	02	01	H3952_053_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3952	053	0	1	02	01	H3952_053_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3952	053	0	1	02	01	H3952_053_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3952	054	0	1	02	01	H3952_054_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3952	054	0	1	02	01	H3952_054_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3952	054	0	1	02	01	H3952_054_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3952	054	0	1	02	01	H3952_054_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3952	054	0	1	02	01	H3952_054_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3952	055	0	1	01	01	H3952_055_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3952	055	0	1	01	01	H3952_055_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3952	055	0	1	01	01	H3952_055_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3952	055	0	1	01	01	H3952_055_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3952	055	0	1	01	01	H3952_055_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3952	056	0	1	01	01	H3952_056_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3952	056	0	1	01	01	H3952_056_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3952	056	0	1	01	01	H3952_056_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3952	056	0	1	01	01	H3952_056_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3952	056	0	1	01	01	H3952_056_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3954	157	13	1	01	01	H3954_157_13	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	157	13	1	01	01	H3954_157_13	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	157	13	1	01	01	H3954_157_13	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	157	13	1	01	01	H3954_157_13	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	157	13	1	01	01	H3954_157_13	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	157	13	1	01	01	H3954_157_13	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	157	14	1	01	01	H3954_157_14	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	157	14	1	01	01	H3954_157_14	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	157	14	1	01	01	H3954_157_14	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	157	14	1	01	01	H3954_157_14	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	157	14	1	01	01	H3954_157_14	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	157	14	1	01	01	H3954_157_14	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	157	15	1	01	01	H3954_157_15	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	157	15	1	01	01	H3954_157_15	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	157	15	1	01	01	H3954_157_15	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	157	15	1	01	01	H3954_157_15	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	157	15	1	01	01	H3954_157_15	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	157	15	1	01	01	H3954_157_15	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	157	16	1	01	01	H3954_157_16	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	157	16	1	01	01	H3954_157_16	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	157	16	1	01	01	H3954_157_16	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	157	16	1	01	01	H3954_157_16	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	157	16	1	01	01	H3954_157_16	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	157	16	1	01	01	H3954_157_16	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	157	17	1	01	01	H3954_157_17	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	157	17	1	01	01	H3954_157_17	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	157	17	1	01	01	H3954_157_17	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	157	17	1	01	01	H3954_157_17	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	157	17	1	01	01	H3954_157_17	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	157	17	1	01	01	H3954_157_17	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	157	18	1	01	01	H3954_157_18	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	157	18	1	01	01	H3954_157_18	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	157	18	1	01	01	H3954_157_18	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	157	18	1	01	01	H3954_157_18	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	157	18	1	01	01	H3954_157_18	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	157	18	1	01	01	H3954_157_18	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	158	13	1	01	01	H3954_158_13	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	158	13	1	01	01	H3954_158_13	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	158	13	1	01	01	H3954_158_13	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	158	13	1	01	01	H3954_158_13	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	158	13	1	01	01	H3954_158_13	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	158	13	1	01	01	H3954_158_13	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	158	14	1	01	01	H3954_158_14	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	158	14	1	01	01	H3954_158_14	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	158	14	1	01	01	H3954_158_14	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	158	14	1	01	01	H3954_158_14	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	158	14	1	01	01	H3954_158_14	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	158	14	1	01	01	H3954_158_14	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	158	15	1	01	01	H3954_158_15	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	158	15	1	01	01	H3954_158_15	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	158	15	1	01	01	H3954_158_15	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	158	15	1	01	01	H3954_158_15	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	158	15	1	01	01	H3954_158_15	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	158	15	1	01	01	H3954_158_15	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	158	16	1	01	01	H3954_158_16	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	158	16	1	01	01	H3954_158_16	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	158	16	1	01	01	H3954_158_16	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	158	16	1	01	01	H3954_158_16	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	158	16	1	01	01	H3954_158_16	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	158	16	1	01	01	H3954_158_16	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	158	17	1	01	01	H3954_158_17	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	158	17	1	01	01	H3954_158_17	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	158	17	1	01	01	H3954_158_17	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	158	17	1	01	01	H3954_158_17	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	158	17	1	01	01	H3954_158_17	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	158	17	1	01	01	H3954_158_17	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	158	18	1	01	01	H3954_158_18	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	158	18	1	01	01	H3954_158_18	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	158	18	1	01	01	H3954_158_18	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	158	18	1	01	01	H3954_158_18	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	158	18	1	01	01	H3954_158_18	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	158	18	1	01	01	H3954_158_18	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	159	13	1	01	01	H3954_159_13	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	159	13	1	01	01	H3954_159_13	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	159	13	1	01	01	H3954_159_13	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	159	13	1	01	01	H3954_159_13	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	159	13	1	01	01	H3954_159_13	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	159	13	1	01	01	H3954_159_13	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	159	14	1	01	01	H3954_159_14	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	159	14	1	01	01	H3954_159_14	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	159	14	1	01	01	H3954_159_14	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	159	14	1	01	01	H3954_159_14	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	159	14	1	01	01	H3954_159_14	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	159	14	1	01	01	H3954_159_14	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	159	15	1	01	01	H3954_159_15	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	159	15	1	01	01	H3954_159_15	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	159	15	1	01	01	H3954_159_15	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	159	15	1	01	01	H3954_159_15	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	159	15	1	01	01	H3954_159_15	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	159	15	1	01	01	H3954_159_15	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	159	16	1	01	01	H3954_159_16	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	159	16	1	01	01	H3954_159_16	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	159	16	1	01	01	H3954_159_16	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	159	16	1	01	01	H3954_159_16	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	159	16	1	01	01	H3954_159_16	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	159	16	1	01	01	H3954_159_16	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	159	17	1	01	01	H3954_159_17	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	159	17	1	01	01	H3954_159_17	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	159	17	1	01	01	H3954_159_17	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	159	17	1	01	01	H3954_159_17	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	159	17	1	01	01	H3954_159_17	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	159	17	1	01	01	H3954_159_17	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	159	18	1	01	01	H3954_159_18	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	159	18	1	01	01	H3954_159_18	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	159	18	1	01	01	H3954_159_18	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	159	18	1	01	01	H3954_159_18	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	159	18	1	01	01	H3954_159_18	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	159	18	1	01	01	H3954_159_18	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3954	160	0	1	01	01	H3954_160_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H3954	160	0	1	01	01	H3954_160_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H3954	160	0	1	01	01	H3954_160_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H3954	160	0	1	01	01	H3954_160_0	3	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H3954	160	0	1	01	01	H3954_160_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H3954	160	0	1	01	01	H3954_160_0	3	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H3957	031	0	1	02	01	H3957_031_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	031	0	1	02	01	H3957_031_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	031	0	1	02	01	H3957_031_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	031	0	1	02	01	H3957_031_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	031	0	1	02	01	H3957_031_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	039	0	1	01	01	H3957_039_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	039	0	1	01	01	H3957_039_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	039	0	1	01	01	H3957_039_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	039	0	1	01	01	H3957_039_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	039	0	1	01	01	H3957_039_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	042	1	1	01	01	H3957_042_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	042	1	1	01	01	H3957_042_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	042	1	1	01	01	H3957_042_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	042	1	1	01	01	H3957_042_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	042	1	1	01	01	H3957_042_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	042	2	1	01	01	H3957_042_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	042	2	1	01	01	H3957_042_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	042	2	1	01	01	H3957_042_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	042	2	1	01	01	H3957_042_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	042	2	1	01	01	H3957_042_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	042	4	1	01	01	H3957_042_4	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	042	4	1	01	01	H3957_042_4	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	042	4	1	01	01	H3957_042_4	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	042	4	1	01	01	H3957_042_4	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	042	4	1	01	01	H3957_042_4	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	042	5	1	01	01	H3957_042_5	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	042	5	1	01	01	H3957_042_5	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	042	5	1	01	01	H3957_042_5	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	042	5	1	01	01	H3957_042_5	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	042	5	1	01	01	H3957_042_5	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	044	1	1	02	01	H3957_044_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	044	1	1	02	01	H3957_044_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	044	1	1	02	01	H3957_044_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	044	1	1	02	01	H3957_044_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	044	1	1	02	01	H3957_044_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	044	2	1	02	01	H3957_044_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	044	2	1	02	01	H3957_044_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	044	2	1	02	01	H3957_044_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	044	2	1	02	01	H3957_044_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	044	2	1	02	01	H3957_044_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	045	1	1	02	01	H3957_045_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	045	1	1	02	01	H3957_045_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	045	1	1	02	01	H3957_045_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	045	1	1	02	01	H3957_045_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	045	1	1	02	01	H3957_045_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	045	2	1	02	01	H3957_045_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	045	2	1	02	01	H3957_045_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	045	2	1	02	01	H3957_045_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	045	2	1	02	01	H3957_045_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	045	2	1	02	01	H3957_045_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	045	3	1	02	01	H3957_045_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	045	3	1	02	01	H3957_045_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	045	3	1	02	01	H3957_045_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	045	3	1	02	01	H3957_045_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	045	3	1	02	01	H3957_045_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	046	1	1	02	01	H3957_046_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	046	1	1	02	01	H3957_046_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	046	1	1	02	01	H3957_046_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	046	1	1	02	01	H3957_046_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	046	1	1	02	01	H3957_046_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	046	2	1	02	01	H3957_046_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	046	2	1	02	01	H3957_046_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	046	2	1	02	01	H3957_046_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	046	2	1	02	01	H3957_046_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	046	2	1	02	01	H3957_046_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	046	3	1	02	01	H3957_046_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	046	3	1	02	01	H3957_046_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	046	3	1	02	01	H3957_046_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	046	3	1	02	01	H3957_046_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	046	3	1	02	01	H3957_046_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	047	1	1	01	01	H3957_047_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	047	1	1	01	01	H3957_047_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	047	1	1	01	01	H3957_047_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	047	1	1	01	01	H3957_047_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	047	1	1	01	01	H3957_047_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3957	047	2	1	01	01	H3957_047_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3957	047	2	1	01	01	H3957_047_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3957	047	2	1	01	01	H3957_047_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3957	047	2	1	01	01	H3957_047_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3957	047	2	1	01	01	H3957_047_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	001	0	1	01	01	H3959_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	001	0	1	01	01	H3959_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	001	0	1	01	01	H3959_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	001	0	1	01	01	H3959_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	001	0	1	01	01	H3959_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	002	0	1	01	01	H3959_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	002	0	1	01	01	H3959_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	002	0	1	01	01	H3959_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	002	0	1	01	01	H3959_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	002	0	1	01	01	H3959_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	010	0	1	01	01	H3959_010_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	010	0	1	01	01	H3959_010_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	010	0	1	01	01	H3959_010_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	010	0	1	01	01	H3959_010_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	010	0	1	01	01	H3959_010_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	011	0	1	01	01	H3959_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	011	0	1	01	01	H3959_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	011	0	1	01	01	H3959_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	011	0	1	01	01	H3959_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	011	0	1	01	01	H3959_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	032	0	1	01	01	H3959_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	032	0	1	01	01	H3959_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	032	0	1	01	01	H3959_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	032	0	1	01	01	H3959_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	032	0	1	01	01	H3959_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	033	0	1	01	01	H3959_033_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3959	033	0	1	01	01	H3959_033_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3959	033	0	1	01	01	H3959_033_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	033	0	1	01	01	H3959_033_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	033	0	1	01	01	H3959_033_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	035	0	1	01	01	H3959_035_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3959	035	0	1	01	01	H3959_035_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3959	035	0	1	01	01	H3959_035_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	035	0	1	01	01	H3959_035_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	035	0	1	01	01	H3959_035_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	036	0	1	01	01	H3959_036_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3959	036	0	1	01	01	H3959_036_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3959	036	0	1	01	01	H3959_036_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	036	0	1	01	01	H3959_036_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	036	0	1	01	01	H3959_036_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	037	0	1	01	01	H3959_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3959	037	0	1	01	01	H3959_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3959	037	0	1	01	01	H3959_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	037	0	1	01	01	H3959_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	037	0	1	01	01	H3959_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	039	0	1	01	01	H3959_039_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3959	039	0	1	01	01	H3959_039_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3959	039	0	1	01	01	H3959_039_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	039	0	1	01	01	H3959_039_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	039	0	1	01	01	H3959_039_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	045	0	1	01	01	H3959_045_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	045	0	1	01	01	H3959_045_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	045	0	1	01	01	H3959_045_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	045	0	1	01	01	H3959_045_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	045	0	1	01	01	H3959_045_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	046	0	1	01	01	H3959_046_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	046	0	1	01	01	H3959_046_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	046	0	1	01	01	H3959_046_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	046	0	1	01	01	H3959_046_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	046	0	1	01	01	H3959_046_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	047	0	1	01	01	H3959_047_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	047	0	1	01	01	H3959_047_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	047	0	1	01	01	H3959_047_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	047	0	1	01	01	H3959_047_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	047	0	1	01	01	H3959_047_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	049	0	1	01	01	H3959_049_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	049	0	1	01	01	H3959_049_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	049	0	1	01	01	H3959_049_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	049	0	1	01	01	H3959_049_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	049	0	1	01	01	H3959_049_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	051	0	1	01	01	H3959_051_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	051	0	1	01	01	H3959_051_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	051	0	1	01	01	H3959_051_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	051	0	1	01	01	H3959_051_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	051	0	1	01	01	H3959_051_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	052	0	1	01	01	H3959_052_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3959	052	0	1	01	01	H3959_052_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3959	052	0	1	01	01	H3959_052_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	052	0	1	01	01	H3959_052_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	052	0	1	01	01	H3959_052_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	053	0	1	01	01	H3959_053_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H3959	053	0	1	01	01	H3959_053_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H3959	053	0	1	01	01	H3959_053_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	053	0	1	01	01	H3959_053_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	053	0	1	01	01	H3959_053_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3959	055	0	1	01	01	H3959_055_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3959	055	0	1	01	01	H3959_055_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H3959	055	0	1	01	01	H3959_055_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3959	055	0	1	01	01	H3959_055_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3959	055	0	1	01	01	H3959_055_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3962	001	0	1	01	01	H3962_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3962	001	0	1	01	01	H3962_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3962	001	0	1	01	01	H3962_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3962	001	0	1	01	01	H3962_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3962	001	0	1	01	01	H3962_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3962	001	0	1	01	01	H3962_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3962	004	0	1	01	01	H3962_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3962	004	0	1	01	01	H3962_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3962	004	0	1	01	01	H3962_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3962	004	0	1	01	01	H3962_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3962	004	0	1	01	01	H3962_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3962	004	0	1	01	01	H3962_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3962	007	0	1	01	01	H3962_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H3962	007	0	1	01	01	H3962_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H3962	007	0	1	01	01	H3962_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H3962	007	0	1	01	01	H3962_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H3962	007	0	1	01	01	H3962_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H3962	007	0	1	01	01	H3962_007_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H3975	001	0	1	04	01	H3975_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H3975	001	0	1	04	01	H3975_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3975	001	0	1	04	01	H3975_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3975	001	0	1	04	01	H3975_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3975	001	0	1	04	01	H3975_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H3979	001	0	1	01	01	H3979_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H3979	001	0	1	01	01	H3979_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H3979	001	0	1	01	01	H3979_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H3979	001	0	1	01	01	H3979_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H3979	001	0	1	01	01	H3979_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4003	009	0	1	01	01	H4003_009_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H4003	009	0	1	01	01	H4003_009_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H4003	009	0	1	01	01	H4003_009_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H4003	009	0	1	01	01	H4003_009_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H4003	009	0	1	01	01	H4003_009_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H4003	019	0	1	02	01	H4003_019_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H4003	019	0	1	02	01	H4003_019_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H4003	019	0	1	02	01	H4003_019_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	3						
H4003	019	0	1	02	01	H4003_019_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H4003	019	0	1	02	01	H4003_019_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H4003	034	0	1	02	01	H4003_034_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H4003	034	0	1	02	01	H4003_034_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H4003	034	0	1	02	01	H4003_034_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	3						
H4003	034	0	1	02	01	H4003_034_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H4003	034	0	1	02	01	H4003_034_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H4003	044	0	1	02	01	H4003_044_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H4003	044	0	1	02	01	H4003_044_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H4003	044	0	1	02	01	H4003_044_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H4003	044	0	1	02	01	H4003_044_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H4003	044	0	1	02	01	H4003_044_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H4003	051	0	1	02	01	H4003_051_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H4003	051	0	1	02	01	H4003_051_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H4003	051	0	1	02	01	H4003_051_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H4003	051	0	1	02	01	H4003_051_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H4003	051	0	1	02	01	H4003_051_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H4004	056	0	1	02	01	H4004_056_0	14	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H4004	056	0	1	02	01	H4004_056_0	14	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H4004	056	0	1	02	01	H4004_056_0	14	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	3						
H4004	056	0	1	02	01	H4004_056_0	14	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H4004	056	0	1	02	01	H4004_056_0	14	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H4005	004	0	1	04	01	H4005_004_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	3						
H4005	004	0	1	04	01	H4005_004_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H4005	004	0	1	04	01	H4005_004_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	3						
H4005	004	0	1	04	01	H4005_004_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	3						
H4005	004	0	1	04	01	H4005_004_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4005	004	0	1	04	01	H4005_004_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H4007	012	0	1	01	01	H4007_012_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H4007	012	0	1	01	01	H4007_012_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4007	012	0	1	01	01	H4007_012_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4007	012	0	1	01	01	H4007_012_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4007	012	0	1	01	01	H4007_012_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4007	012	0	1	01	01	H4007_012_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4007	013	0	1	01	01	H4007_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H4007	013	0	1	01	01	H4007_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4007	013	0	1	01	01	H4007_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4007	013	0	1	01	01	H4007_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4007	013	0	1	01	01	H4007_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4007	013	0	1	01	01	H4007_013_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4007	020	0	1	01	01	H4007_020_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H4007	020	0	1	01	01	H4007_020_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4007	020	0	1	01	01	H4007_020_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4007	020	0	1	01	01	H4007_020_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4007	020	0	1	01	01	H4007_020_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4007	020	0	1	01	01	H4007_020_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4007	021	0	1	01	01	H4007_021_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H4007	021	0	1	01	01	H4007_021_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4007	021	0	1	01	01	H4007_021_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4007	021	0	1	01	01	H4007_021_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4007	021	0	1	01	01	H4007_021_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4007	021	0	1	01	01	H4007_021_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4036	008	0	1	04	01	H4036_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4036	008	0	1	04	01	H4036_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4036	008	0	1	04	01	H4036_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4036	008	0	1	04	01	H4036_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4036	008	0	1	04	01	H4036_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4036	008	0	1	04	01	H4036_008_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4036	009	0	1	04	01	H4036_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4036	009	0	1	04	01	H4036_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4036	009	0	1	04	01	H4036_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4036	009	0	1	04	01	H4036_009_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4036	009	0	1	04	01	H4036_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4036	009	0	1	04	01	H4036_009_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4036	010	1	1	04	01	H4036_010_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4036	010	1	1	04	01	H4036_010_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4036	010	1	1	04	01	H4036_010_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4036	010	1	1	04	01	H4036_010_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4036	010	1	1	04	01	H4036_010_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4036	010	1	1	04	01	H4036_010_1	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4036	010	2	1	04	01	H4036_010_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4036	010	2	1	04	01	H4036_010_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4036	010	2	1	04	01	H4036_010_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4036	010	2	1	04	01	H4036_010_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4036	010	2	1	04	01	H4036_010_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4036	010	2	1	04	01	H4036_010_2	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4036	017	0	1	04	01	H4036_017_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4036	017	0	1	04	01	H4036_017_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4036	017	0	1	04	01	H4036_017_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4036	017	0	1	04	01	H4036_017_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4036	017	0	1	04	01	H4036_017_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4036	017	0	1	04	01	H4036_017_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4036	020	0	1	04	01	H4036_020_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4036	020	0	1	04	01	H4036_020_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4036	020	0	1	04	01	H4036_020_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4036	020	0	1	04	01	H4036_020_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4036	020	0	1	04	01	H4036_020_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4036	020	0	1	04	01	H4036_020_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4091	003	0	1	04	01	H4091_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H4091	003	0	1	04	01	H4091_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H4091	003	0	1	04	01	H4091_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H4091	003	0	1	04	01	H4091_003_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H4091	003	0	1	04	01	H4091_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H4140	001	0	1	02	01	H4140_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4140	001	0	1	02	01	H4140_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4140	001	0	1	02	01	H4140_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4140	001	0	1	02	01	H4140_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4140	001	0	1	02	01	H4140_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4140	002	0	1	02	01	H4140_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4140	002	0	1	02	01	H4140_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4140	002	0	1	02	01	H4140_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4140	002	0	1	02	01	H4140_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4140	002	0	1	02	01	H4140_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4140	003	0	1	02	01	H4140_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4140	003	0	1	02	01	H4140_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4140	003	0	1	02	01	H4140_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4140	003	0	1	02	01	H4140_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4140	003	0	1	02	01	H4140_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4140	004	0	1	02	01	H4140_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4140	004	0	1	02	01	H4140_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4140	004	0	1	02	01	H4140_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4140	004	0	1	02	01	H4140_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4140	004	0	1	02	01	H4140_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4140	005	0	1	02	01	H4140_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4140	005	0	1	02	01	H4140_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4140	005	0	1	02	01	H4140_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4140	005	0	1	02	01	H4140_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4140	005	0	1	02	01	H4140_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4140	006	0	1	02	01	H4140_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4140	006	0	1	02	01	H4140_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4140	006	0	1	02	01	H4140_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4140	006	0	1	02	01	H4140_006_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4140	006	0	1	02	01	H4140_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4140	007	0	1	02	01	H4140_007_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4140	007	0	1	02	01	H4140_007_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4140	007	0	1	02	01	H4140_007_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4140	007	0	1	02	01	H4140_007_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4140	007	0	1	02	01	H4140_007_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4141	003	0	1	01	01	H4141_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4141	003	0	1	01	01	H4141_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4141	003	0	1	01	01	H4141_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4141	003	0	1	01	01	H4141_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4141	003	0	1	01	01	H4141_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4141	015	0	1	01	01	H4141_015_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4141	015	0	1	01	01	H4141_015_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4141	015	0	1	01	01	H4141_015_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4141	015	0	1	01	01	H4141_015_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4141	015	0	1	01	01	H4141_015_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4141	017	3	1	01	01	H4141_017_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4141	017	3	1	01	01	H4141_017_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4141	017	3	1	01	01	H4141_017_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4141	017	3	1	01	01	H4141_017_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4141	017	3	1	01	01	H4141_017_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4141	017	4	1	01	01	H4141_017_4	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4141	017	4	1	01	01	H4141_017_4	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4141	017	4	1	01	01	H4141_017_4	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4141	017	4	1	01	01	H4141_017_4	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4141	017	4	1	01	01	H4141_017_4	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4141	017	5	1	01	01	H4141_017_5	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4141	017	5	1	01	01	H4141_017_5	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4141	017	5	1	01	01	H4141_017_5	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4141	017	5	1	01	01	H4141_017_5	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4141	017	5	1	01	01	H4141_017_5	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4152	005	0	1	01	01	H4152_005_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4152	005	0	1	01	01	H4152_005_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4152	005	0	1	01	01	H4152_005_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4152	005	0	1	01	01	H4152_005_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4152	005	0	1	01	01	H4152_005_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4152	007	0	1	02	01	H4152_007_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4152	007	0	1	02	01	H4152_007_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4152	007	0	1	02	01	H4152_007_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4152	007	0	1	02	01	H4152_007_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4152	007	0	1	02	01	H4152_007_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4152	013	0	1	01	01	H4152_013_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4152	013	0	1	01	01	H4152_013_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4152	013	0	1	01	01	H4152_013_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4152	013	0	1	01	01	H4152_013_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4152	013	0	1	01	01	H4152_013_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4152	017	0	1	01	01	H4152_017_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4152	017	0	1	01	01	H4152_017_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4152	017	0	1	01	01	H4152_017_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4152	017	0	1	01	01	H4152_017_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4152	017	0	1	01	01	H4152_017_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4152	018	0	1	02	01	H4152_018_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4152	018	0	1	02	01	H4152_018_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4152	018	0	1	02	01	H4152_018_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4152	018	0	1	02	01	H4152_018_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4152	018	0	1	02	01	H4152_018_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4152	020	0	1	02	01	H4152_020_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4152	020	0	1	02	01	H4152_020_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4152	020	0	1	02	01	H4152_020_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4152	020	0	1	02	01	H4152_020_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4152	020	0	1	02	01	H4152_020_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4172	002	0	1	01	01	H4172_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H4172	002	0	1	01	01	H4172_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H4172	002	0	1	01	01	H4172_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H4172	002	0	1	01	01	H4172_002_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H4172	002	0	1	01	01	H4172_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H4198	003	0	1	01	01	H4198_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4198	003	0	1	01	01	H4198_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4198	003	0	1	01	01	H4198_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4198	003	0	1	01	01	H4198_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4198	003	0	1	01	01	H4198_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4198	005	0	1	01	01	H4198_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4198	005	0	1	01	01	H4198_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4198	005	0	1	01	01	H4198_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4198	005	0	1	01	01	H4198_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4198	005	0	1	01	01	H4198_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4213	017	1	1	09	04	H4213_017_1	8	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4213	017	1	1	09	04	H4213_017_1	8	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4213	017	1	1	09	04	H4213_017_1	8	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4213	017	1	1	09	04	H4213_017_1	8	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4213	017	1	1	09	04	H4213_017_1	8	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4213	017	5	1	09	04	H4213_017_5	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4213	017	5	1	09	04	H4213_017_5	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4213	017	5	1	09	04	H4213_017_5	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4213	017	5	1	09	04	H4213_017_5	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4213	017	5	1	09	04	H4213_017_5	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4213	017	6	1	09	04	H4213_017_6	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4213	017	6	1	09	04	H4213_017_6	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4213	017	6	1	09	04	H4213_017_6	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4213	017	6	1	09	04	H4213_017_6	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4213	017	6	1	09	04	H4213_017_6	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4227	001	0	1	01	01	H4227_001_0	6	Generic	2	Generic, Brand	1	2	01	1						
H4227	001	0	1	01	01	H4227_001_0	6	Brand	2	Generic, Brand	2	2	11	1						
H4227	002	0	1	01	01	H4227_002_0	6	Generic	2	Generic, Brand	1	2	01	1						
H4227	002	0	1	01	01	H4227_002_0	6	Brand	2	Generic, Brand	2	2	11	1						
H4279	001	0	1	01	01	H4279_001_0	9	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4279	001	0	1	01	01	H4279_001_0	9	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4279	001	0	1	01	01	H4279_001_0	9	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4279	001	0	1	01	01	H4279_001_0	9	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4279	001	0	1	01	01	H4279_001_0	9	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4279	004	0	1	01	01	H4279_004_0	8	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4279	004	0	1	01	01	H4279_004_0	8	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4279	004	0	1	01	01	H4279_004_0	8	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4279	004	0	1	01	01	H4279_004_0	8	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4279	004	0	1	01	01	H4279_004_0	8	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4304	001	0	1	04	01	H4304_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4304	001	0	1	04	01	H4304_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4304	001	0	1	04	01	H4304_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4304	001	0	1	04	01	H4304_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4304	001	0	1	04	01	H4304_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4343	001	0	1	01	01	H4343_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4343	001	0	1	01	01	H4343_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4343	001	0	1	01	01	H4343_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4343	001	0	1	01	01	H4343_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4343	001	0	1	01	01	H4343_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4343	001	0	1	01	01	H4343_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4343	002	0	1	01	01	H4343_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4343	002	0	1	01	01	H4343_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4343	002	0	1	01	01	H4343_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4343	002	0	1	01	01	H4343_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4343	002	0	1	01	01	H4343_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4343	002	0	1	01	01	H4343_002_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4343	003	0	1	01	01	H4343_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4343	003	0	1	01	01	H4343_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4343	003	0	1	01	01	H4343_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4343	003	0	1	01	01	H4343_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4343	003	0	1	01	01	H4343_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4343	003	0	1	01	01	H4343_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4343	004	0	1	01	01	H4343_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4343	004	0	1	01	01	H4343_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4343	004	0	1	01	01	H4343_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4343	004	0	1	01	01	H4343_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4343	004	0	1	01	01	H4343_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4343	004	0	1	01	01	H4343_004_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4346	001	0	1	01	01	H4346_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H4346	001	0	1	01	01	H4346_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H4346	001	0	1	01	01	H4346_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H4346	001	0	1	01	01	H4346_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H4346	001	0	1	01	01	H4346_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H4346	001	0	1	01	01	H4346_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H4346	005	0	1	01	01	H4346_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H4346	005	0	1	01	01	H4346_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H4346	005	0	1	01	01	H4346_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H4346	005	0	1	01	01	H4346_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H4346	005	0	1	01	01	H4346_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H4346	005	0	1	01	01	H4346_005_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H4346	006	0	1	01	01	H4346_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H4346	006	0	1	01	01	H4346_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H4346	006	0	1	01	01	H4346_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H4346	006	0	1	01	01	H4346_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H4346	006	0	1	01	01	H4346_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H4346	006	0	1	01	01	H4346_006_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H4346	008	0	1	01	01	H4346_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H4346	008	0	1	01	01	H4346_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H4346	008	0	1	01	01	H4346_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H4346	008	0	1	01	01	H4346_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H4346	008	0	1	01	01	H4346_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H4346	008	0	1	01	01	H4346_008_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H4346	009	0	1	01	01	H4346_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H4346	009	0	1	01	01	H4346_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H4346	009	0	1	01	01	H4346_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H4346	009	0	1	01	01	H4346_009_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H4346	009	0	1	01	01	H4346_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H4346	009	0	1	01	01	H4346_009_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H4346	010	0	1	01	01	H4346_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H4346	010	0	1	01	01	H4346_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H4346	010	0	1	01	01	H4346_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H4346	010	0	1	01	01	H4346_010_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H4346	010	0	1	01	01	H4346_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H4346	010	0	1	01	01	H4346_010_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H4346	011	0	1	01	01	H4346_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4346	011	0	1	01	01	H4346_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4346	011	0	1	01	01	H4346_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4346	011	0	1	01	01	H4346_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4346	011	0	1	01	01	H4346_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4346	011	0	1	01	01	H4346_011_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4346	012	0	1	01	01	H4346_012_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4346	012	0	1	01	01	H4346_012_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4346	012	0	1	01	01	H4346_012_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4346	012	0	1	01	01	H4346_012_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4346	012	0	1	01	01	H4346_012_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4346	012	0	1	01	01	H4346_012_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4346	013	0	1	01	01	H4346_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4346	013	0	1	01	01	H4346_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4346	013	0	1	01	01	H4346_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4346	013	0	1	01	01	H4346_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4346	013	0	1	01	01	H4346_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4346	013	0	1	01	01	H4346_013_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4346	014	0	1	01	01	H4346_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H4346	014	0	1	01	01	H4346_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H4346	014	0	1	01	01	H4346_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H4346	014	0	1	01	01	H4346_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H4346	014	0	1	01	01	H4346_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H4346	014	0	1	01	01	H4346_014_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H4346	017	0	1	01	01	H4346_017_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H4346	017	0	1	01	01	H4346_017_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H4346	017	0	1	01	01	H4346_017_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H4346	017	0	1	01	01	H4346_017_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H4346	017	0	1	01	01	H4346_017_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H4346	018	0	1	01	01	H4346_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H4346	018	0	1	01	01	H4346_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H4346	018	0	1	01	01	H4346_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H4346	018	0	1	01	01	H4346_018_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H4346	018	0	1	01	01	H4346_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H4346	019	0	1	01	01	H4346_019_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1	2	0.00				
H4346	019	0	1	01	01	H4346_019_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H4346	019	0	1	01	01	H4346_019_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H4346	019	0	1	01	01	H4346_019_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H4346	019	0	1	01	01	H4346_019_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H4346	022	0	1	01	01	H4346_022_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H4346	022	0	1	01	01	H4346_022_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H4346	022	0	1	01	01	H4346_022_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H4346	022	0	1	01	01	H4346_022_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H4346	022	0	1	01	01	H4346_022_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H4346	022	0	1	01	01	H4346_022_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H4346	023	0	1	01	01	H4346_023_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H4346	023	0	1	01	01	H4346_023_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H4346	023	0	1	01	01	H4346_023_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H4346	023	0	1	01	01	H4346_023_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H4346	023	0	1	01	01	H4346_023_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H4346	023	0	1	01	01	H4346_023_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H4346	024	0	1	01	01	H4346_024_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H4346	024	0	1	01	01	H4346_024_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H4346	024	0	1	01	01	H4346_024_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H4346	024	0	1	01	01	H4346_024_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H4346	024	0	1	01	01	H4346_024_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H4346	025	0	1	01	01	H4346_025_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3	2	0.00				
H4346	025	0	1	01	01	H4346_025_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1	3	3.70	5			
H4346	025	0	1	01	01	H4346_025_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1	3	9.20	5			
H4346	025	0	1	01	01	H4346_025_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1	3	9.20	5			
H4346	025	0	1	01	01	H4346_025_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1	3	9.20	5			
H4346	026	0	1	01	01	H4346_026_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4346	026	0	1	01	01	H4346_026_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4346	026	0	1	01	01	H4346_026_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4346	026	0	1	01	01	H4346_026_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4346	026	0	1	01	01	H4346_026_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4346	026	0	1	01	01	H4346_026_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H4407	026	0	1	01	01	H4407_026_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4407	026	0	1	01	01	H4407_026_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4407	026	0	1	01	01	H4407_026_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4407	026	0	1	01	01	H4407_026_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4407	026	0	1	01	01	H4407_026_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4407	027	0	1	01	01	H4407_027_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4407	027	0	1	01	01	H4407_027_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4407	027	0	1	01	01	H4407_027_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4407	027	0	1	01	01	H4407_027_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4407	027	0	1	01	01	H4407_027_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	022	0	1	01	01	H4461_022_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	022	0	1	01	01	H4461_022_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	022	0	1	01	01	H4461_022_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	022	0	1	01	01	H4461_022_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	022	0	1	01	01	H4461_022_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	025	0	1	02	01	H4461_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	025	0	1	02	01	H4461_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	025	0	1	02	01	H4461_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	025	0	1	02	01	H4461_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	025	0	1	02	01	H4461_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	029	0	1	02	01	H4461_029_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	029	0	1	02	01	H4461_029_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	029	0	1	02	01	H4461_029_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	029	0	1	02	01	H4461_029_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	029	0	1	02	01	H4461_029_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	030	1	1	02	01	H4461_030_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	030	1	1	02	01	H4461_030_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	030	1	1	02	01	H4461_030_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	030	1	1	02	01	H4461_030_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	030	1	1	02	01	H4461_030_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	030	2	1	02	01	H4461_030_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	030	2	1	02	01	H4461_030_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	030	2	1	02	01	H4461_030_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	030	2	1	02	01	H4461_030_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	030	2	1	02	01	H4461_030_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	030	3	1	02	01	H4461_030_3	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	030	3	1	02	01	H4461_030_3	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	030	3	1	02	01	H4461_030_3	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	030	3	1	02	01	H4461_030_3	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	030	3	1	02	01	H4461_030_3	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	031	1	1	02	01	H4461_031_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	031	1	1	02	01	H4461_031_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	031	1	1	02	01	H4461_031_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	031	1	1	02	01	H4461_031_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	031	1	1	02	01	H4461_031_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	031	2	1	02	01	H4461_031_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	031	2	1	02	01	H4461_031_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	031	2	1	02	01	H4461_031_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	031	2	1	02	01	H4461_031_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	031	2	1	02	01	H4461_031_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	031	3	1	02	01	H4461_031_3	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	031	3	1	02	01	H4461_031_3	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	031	3	1	02	01	H4461_031_3	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	031	3	1	02	01	H4461_031_3	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	031	3	1	02	01	H4461_031_3	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	034	0	1	02	01	H4461_034_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	034	0	1	02	01	H4461_034_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	034	0	1	02	01	H4461_034_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	034	0	1	02	01	H4461_034_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	034	0	1	02	01	H4461_034_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	035	0	1	02	01	H4461_035_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	035	0	1	02	01	H4461_035_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	035	0	1	02	01	H4461_035_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	035	0	1	02	01	H4461_035_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	035	0	1	02	01	H4461_035_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	036	0	1	02	01	H4461_036_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	036	0	1	02	01	H4461_036_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	036	0	1	02	01	H4461_036_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	036	0	1	02	01	H4461_036_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	036	0	1	02	01	H4461_036_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4461	037	0	1	02	01	H4461_037_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H4461	037	0	1	02	01	H4461_037_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4461	037	0	1	02	01	H4461_037_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4461	037	0	1	02	01	H4461_037_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4461	037	0	1	02	01	H4461_037_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4490	002	0	1	01	01	H4490_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4490	002	0	1	01	01	H4490_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4490	002	0	1	01	01	H4490_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4490	002	0	1	01	01	H4490_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4490	002	0	1	01	01	H4490_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4497	001	1	1	04	01	H4497_001_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4497	001	1	1	04	01	H4497_001_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4497	001	1	1	04	01	H4497_001_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4497	001	1	1	04	01	H4497_001_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4497	001	1	1	04	01	H4497_001_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4497	001	2	1	04	01	H4497_001_2	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4497	001	2	1	04	01	H4497_001_2	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4497	001	2	1	04	01	H4497_001_2	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4497	001	2	1	04	01	H4497_001_2	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4497	001	2	1	04	01	H4497_001_2	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4497	001	3	1	04	01	H4497_001_3	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4497	001	3	1	04	01	H4497_001_3	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4497	001	3	1	04	01	H4497_001_3	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4497	001	3	1	04	01	H4497_001_3	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4497	001	3	1	04	01	H4497_001_3	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4497	002	1	1	04	01	H4497_002_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4497	002	1	1	04	01	H4497_002_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4497	002	1	1	04	01	H4497_002_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4497	002	1	1	04	01	H4497_002_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4497	002	1	1	04	01	H4497_002_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4497	002	2	1	04	01	H4497_002_2	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4497	002	2	1	04	01	H4497_002_2	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4497	002	2	1	04	01	H4497_002_2	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4497	002	2	1	04	01	H4497_002_2	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4497	002	2	1	04	01	H4497_002_2	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4497	002	3	1	04	01	H4497_002_3	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4497	002	3	1	04	01	H4497_002_3	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4497	002	3	1	04	01	H4497_002_3	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4497	002	3	1	04	01	H4497_002_3	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4497	002	3	1	04	01	H4497_002_3	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4497	003	1	1	04	01	H4497_003_1	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4497	003	1	1	04	01	H4497_003_1	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4497	003	1	1	04	01	H4497_003_1	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4497	003	1	1	04	01	H4497_003_1	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4497	003	1	1	04	01	H4497_003_1	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4497	003	2	1	04	01	H4497_003_2	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4497	003	2	1	04	01	H4497_003_2	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4497	003	2	1	04	01	H4497_003_2	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4497	003	2	1	04	01	H4497_003_2	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4497	003	2	1	04	01	H4497_003_2	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4497	003	3	1	04	01	H4497_003_3	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4497	003	3	1	04	01	H4497_003_3	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4497	003	3	1	04	01	H4497_003_3	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4497	003	3	1	04	01	H4497_003_3	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4497	003	3	1	04	01	H4497_003_3	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4506	003	0	1	01	01	H4506_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4506	003	0	1	01	01	H4506_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4506	003	0	1	01	01	H4506_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4506	003	0	1	01	01	H4506_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4506	003	0	1	01	01	H4506_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4506	029	0	1	02	01	H4506_029_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4506	029	0	1	02	01	H4506_029_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4506	029	0	1	02	01	H4506_029_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4506	029	0	1	02	01	H4506_029_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4506	029	0	1	02	01	H4506_029_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	026	0	1	01	01	H4513_026_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	026	0	1	01	01	H4513_026_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	026	0	1	01	01	H4513_026_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	026	0	1	01	01	H4513_026_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	026	0	1	01	01	H4513_026_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	028	0	1	01	01	H4513_028_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	028	0	1	01	01	H4513_028_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	028	0	1	01	01	H4513_028_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	028	0	1	01	01	H4513_028_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	028	0	1	01	01	H4513_028_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	030	0	1	01	01	H4513_030_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	030	0	1	01	01	H4513_030_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	030	0	1	01	01	H4513_030_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	030	0	1	01	01	H4513_030_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	030	0	1	01	01	H4513_030_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	036	0	1	02	01	H4513_036_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	036	0	1	02	01	H4513_036_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	036	0	1	02	01	H4513_036_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	036	0	1	02	01	H4513_036_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	036	0	1	02	01	H4513_036_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	037	0	1	01	01	H4513_037_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	037	0	1	01	01	H4513_037_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	037	0	1	01	01	H4513_037_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	037	0	1	01	01	H4513_037_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	037	0	1	01	01	H4513_037_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	038	0	1	01	01	H4513_038_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	038	0	1	01	01	H4513_038_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	038	0	1	01	01	H4513_038_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	038	0	1	01	01	H4513_038_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	038	0	1	01	01	H4513_038_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	042	0	1	01	01	H4513_042_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4513	042	0	1	01	01	H4513_042_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	042	0	1	01	01	H4513_042_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	042	0	1	01	01	H4513_042_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	042	0	1	01	01	H4513_042_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	043	0	1	01	01	H4513_043_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	043	0	1	01	01	H4513_043_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	043	0	1	01	01	H4513_043_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	043	0	1	01	01	H4513_043_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	043	0	1	01	01	H4513_043_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	046	1	1	01	01	H4513_046_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	046	1	1	01	01	H4513_046_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4513	046	1	1	01	01	H4513_046_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	046	1	1	01	01	H4513_046_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	046	1	1	01	01	H4513_046_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	046	2	1	01	01	H4513_046_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	046	2	1	01	01	H4513_046_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4513	046	2	1	01	01	H4513_046_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	046	2	1	01	01	H4513_046_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	046	2	1	01	01	H4513_046_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	047	0	1	01	01	H4513_047_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	047	0	1	01	01	H4513_047_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4513	047	0	1	01	01	H4513_047_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	047	0	1	01	01	H4513_047_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	047	0	1	01	01	H4513_047_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	048	0	1	01	01	H4513_048_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	048	0	1	01	01	H4513_048_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4513	048	0	1	01	01	H4513_048_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	048	0	1	01	01	H4513_048_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	048	0	1	01	01	H4513_048_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	049	1	1	01	01	H4513_049_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	049	1	1	01	01	H4513_049_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	049	1	1	01	01	H4513_049_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	049	1	1	01	01	H4513_049_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	049	1	1	01	01	H4513_049_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	049	2	1	01	01	H4513_049_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	049	2	1	01	01	H4513_049_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	049	2	1	01	01	H4513_049_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	049	2	1	01	01	H4513_049_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	049	2	1	01	01	H4513_049_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	050	0	1	01	01	H4513_050_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	050	0	1	01	01	H4513_050_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	050	0	1	01	01	H4513_050_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	050	0	1	01	01	H4513_050_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	050	0	1	01	01	H4513_050_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	051	0	1	01	01	H4513_051_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	051	0	1	01	01	H4513_051_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	051	0	1	01	01	H4513_051_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	051	0	1	01	01	H4513_051_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	051	0	1	01	01	H4513_051_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	052	0	1	01	01	H4513_052_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	052	0	1	01	01	H4513_052_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	052	0	1	01	01	H4513_052_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	052	0	1	01	01	H4513_052_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	052	0	1	01	01	H4513_052_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	054	0	1	01	01	H4513_054_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	054	0	1	01	01	H4513_054_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4513	054	0	1	01	01	H4513_054_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	054	0	1	01	01	H4513_054_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	054	0	1	01	01	H4513_054_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	057	0	1	01	01	H4513_057_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	057	0	1	01	01	H4513_057_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4513	057	0	1	01	01	H4513_057_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	057	0	1	01	01	H4513_057_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	057	0	1	01	01	H4513_057_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	059	0	1	01	01	H4513_059_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	059	0	1	01	01	H4513_059_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	059	0	1	01	01	H4513_059_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	059	0	1	01	01	H4513_059_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	059	0	1	01	01	H4513_059_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	061	1	1	01	01	H4513_061_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	061	1	1	01	01	H4513_061_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	061	1	1	01	01	H4513_061_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	061	1	1	01	01	H4513_061_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	061	1	1	01	01	H4513_061_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	061	2	1	01	01	H4513_061_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	061	2	1	01	01	H4513_061_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	061	2	1	01	01	H4513_061_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	061	2	1	01	01	H4513_061_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	061	2	1	01	01	H4513_061_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4513	061	3	1	01	01	H4513_061_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4513	061	3	1	01	01	H4513_061_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4513	061	3	1	01	01	H4513_061_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4513	061	3	1	01	01	H4513_061_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4513	061	3	1	01	01	H4513_061_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4514	007	0	1	01	01	H4514_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4514	007	0	1	01	01	H4514_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4514	007	0	1	01	01	H4514_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4514	007	0	1	01	01	H4514_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4514	007	0	1	01	01	H4514_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4523	001	0	1	01	01	H4523_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4523	001	0	1	01	01	H4523_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4523	001	0	1	01	01	H4523_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4523	001	0	1	01	01	H4523_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4523	001	0	1	01	01	H4523_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4523	015	0	1	01	01	H4523_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4523	015	0	1	01	01	H4523_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4523	015	0	1	01	01	H4523_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4523	015	0	1	01	01	H4523_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4523	015	0	1	01	01	H4523_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4523	020	0	1	01	01	H4523_020_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4523	020	0	1	01	01	H4523_020_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4523	020	0	1	01	01	H4523_020_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4523	020	0	1	01	01	H4523_020_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4523	020	0	1	01	01	H4523_020_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4523	021	0	1	01	01	H4523_021_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4523	021	0	1	01	01	H4523_021_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4523	021	0	1	01	01	H4523_021_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4523	021	0	1	01	01	H4523_021_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4523	021	0	1	01	01	H4523_021_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4523	024	0	1	01	01	H4523_024_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4523	024	0	1	01	01	H4523_024_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4523	024	0	1	01	01	H4523_024_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4527	001	0	1	01	01	H4527_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4527	001	0	1	01	01	H4527_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4527	001	0	1	01	01	H4527_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4527	001	0	1	01	01	H4527_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4527	001	0	1	01	01	H4527_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4527	002	0	1	01	01	H4527_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4527	002	0	1	01	01	H4527_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4527	002	0	1	01	01	H4527_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4527	002	0	1	01	01	H4527_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4527	002	0	1	01	01	H4527_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4527	005	0	1	01	01	H4527_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4527	005	0	1	01	01	H4527_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4527	005	0	1	01	01	H4527_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4527	005	0	1	01	01	H4527_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4527	005	0	1	01	01	H4527_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4527	013	0	1	01	01	H4527_013_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4527	013	0	1	01	01	H4527_013_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4527	013	0	1	01	01	H4527_013_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4527	013	0	1	01	01	H4527_013_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4527	013	0	1	01	01	H4527_013_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4527	037	0	1	02	01	H4527_037_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4527	037	0	1	02	01	H4527_037_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4527	037	0	1	02	01	H4527_037_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4527	037	0	1	02	01	H4527_037_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4527	037	0	1	02	01	H4527_037_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4527	039	0	1	01	01	H4527_039_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4527	039	0	1	01	01	H4527_039_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4527	039	0	1	01	01	H4527_039_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4527	039	0	1	01	01	H4527_039_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4527	039	0	1	01	01	H4527_039_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4527	040	0	1	01	01	H4527_040_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4527	040	0	1	01	01	H4527_040_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4527	040	0	1	01	01	H4527_040_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4527	040	0	1	01	01	H4527_040_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4527	040	0	1	01	01	H4527_040_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4527	041	0	1	01	01	H4527_041_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4527	041	0	1	01	01	H4527_041_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4527	041	0	1	01	01	H4527_041_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4527	041	0	1	01	01	H4527_041_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4527	041	0	1	01	01	H4527_041_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4527	042	0	1	01	01	H4527_042_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4527	042	0	1	01	01	H4527_042_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4527	042	0	1	01	01	H4527_042_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4527	042	0	1	01	01	H4527_042_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4527	042	0	1	01	01	H4527_042_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4544	001	0	1	04	01	H4544_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4544	001	0	1	04	01	H4544_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4544	001	0	1	04	01	H4544_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4544	001	0	1	04	01	H4544_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4544	001	0	1	04	01	H4544_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4590	010	0	1	01	01	H4590_010_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4590	010	0	1	01	01	H4590_010_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4590	010	0	1	01	01	H4590_010_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4590	010	0	1	01	01	H4590_010_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4590	010	0	1	01	01	H4590_010_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4590	012	0	1	02	01	H4590_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4590	012	0	1	02	01	H4590_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4590	012	0	1	02	01	H4590_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4590	012	0	1	02	01	H4590_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4590	012	0	1	02	01	H4590_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4590	025	0	1	01	01	H4590_025_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4590	025	0	1	01	01	H4590_025_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4590	025	0	1	01	01	H4590_025_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4590	025	0	1	01	01	H4590_025_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4590	025	0	1	01	01	H4590_025_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4590	037	0	1	01	01	H4590_037_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4590	037	0	1	01	01	H4590_037_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4590	037	0	1	01	01	H4590_037_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4590	037	0	1	01	01	H4590_037_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4590	037	0	1	01	01	H4590_037_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4590	041	0	1	02	01	H4590_041_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4590	041	0	1	02	01	H4590_041_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4590	041	0	1	02	01	H4590_041_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4590	041	0	1	02	01	H4590_041_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4590	041	0	1	02	01	H4590_041_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4590	042	0	1	02	01	H4590_042_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4590	042	0	1	02	01	H4590_042_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4590	042	0	1	02	01	H4590_042_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4590	042	0	1	02	01	H4590_042_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4590	042	0	1	02	01	H4590_042_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4590	043	0	1	02	01	H4590_043_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4590	043	0	1	02	01	H4590_043_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4590	043	0	1	02	01	H4590_043_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4590	043	0	1	02	01	H4590_043_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4590	043	0	1	02	01	H4590_043_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4590	044	0	1	02	01	H4590_044_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4590	044	0	1	02	01	H4590_044_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4590	044	0	1	02	01	H4590_044_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4590	044	0	1	02	01	H4590_044_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4590	044	0	1	02	01	H4590_044_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	003	0	1	01	01	H4604_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	003	0	1	01	01	H4604_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	003	0	1	01	01	H4604_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	003	0	1	01	01	H4604_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	003	0	1	01	01	H4604_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	011	0	1	01	01	H4604_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	011	0	1	01	01	H4604_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	011	0	1	01	01	H4604_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	011	0	1	01	01	H4604_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	011	0	1	01	01	H4604_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	012	0	1	01	01	H4604_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	012	0	1	01	01	H4604_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	012	0	1	01	01	H4604_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	012	0	1	01	01	H4604_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	012	0	1	01	01	H4604_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	013	0	1	01	01	H4604_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	013	0	1	01	01	H4604_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	013	0	1	01	01	H4604_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	013	0	1	01	01	H4604_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	013	0	1	01	01	H4604_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	014	0	1	01	01	H4604_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	014	0	1	01	01	H4604_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	014	0	1	01	01	H4604_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	014	0	1	01	01	H4604_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	014	0	1	01	01	H4604_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	015	0	1	01	01	H4604_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	015	0	1	01	01	H4604_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	015	0	1	01	01	H4604_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	015	0	1	01	01	H4604_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	015	0	1	01	01	H4604_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	016	0	1	01	01	H4604_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	016	0	1	01	01	H4604_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	016	0	1	01	01	H4604_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	016	0	1	01	01	H4604_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	016	0	1	01	01	H4604_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	017	0	1	01	01	H4604_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	017	0	1	01	01	H4604_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	017	0	1	01	01	H4604_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	017	0	1	01	01	H4604_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	017	0	1	01	01	H4604_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	018	0	1	01	01	H4604_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	018	0	1	01	01	H4604_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	018	0	1	01	01	H4604_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	018	0	1	01	01	H4604_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	018	0	1	01	01	H4604_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4604	020	0	1	01	01	H4604_020_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4604	020	0	1	01	01	H4604_020_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4604	020	0	1	01	01	H4604_020_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4604	020	0	1	01	01	H4604_020_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4604	020	0	1	01	01	H4604_020_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4605	002	0	1	04	01	H4605_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4605	002	0	1	04	01	H4605_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4605	002	0	1	04	01	H4605_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4605	002	0	1	04	01	H4605_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4605	002	0	1	04	01	H4605_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4605	004	0	1	04	01	H4605_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4605	004	0	1	04	01	H4605_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4605	004	0	1	04	01	H4605_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4605	004	0	1	04	01	H4605_004_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4605	004	0	1	04	01	H4605_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4605	007	0	1	04	01	H4605_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4605	007	0	1	04	01	H4605_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4605	007	0	1	04	01	H4605_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4605	007	0	1	04	01	H4605_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4605	007	0	1	04	01	H4605_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4605	008	0	1	04	01	H4605_008_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4605	008	0	1	04	01	H4605_008_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4605	008	0	1	04	01	H4605_008_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4605	008	0	1	04	01	H4605_008_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4605	008	0	1	04	01	H4605_008_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4605	009	0	1	04	01	H4605_009_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4605	009	0	1	04	01	H4605_009_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4605	009	0	1	04	01	H4605_009_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4605	009	0	1	04	01	H4605_009_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4605	009	0	1	04	01	H4605_009_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4623	001	0	1	01	01	H4623_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4623	001	0	1	01	01	H4623_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H4623	001	0	1	01	01	H4623_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4623	001	0	1	01	01	H4623_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4623	001	0	1	01	01	H4623_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4623	002	0	1	01	01	H4623_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4623	002	0	1	01	01	H4623_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H4623	002	0	1	01	01	H4623_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4623	002	0	1	01	01	H4623_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4623	002	0	1	01	01	H4623_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4624	001	0	1	01	01	H4624_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	001	0	1	01	01	H4624_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	001	0	1	01	01	H4624_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	001	0	1	01	01	H4624_001_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	001	0	1	01	01	H4624_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	001	0	1	01	01	H4624_001_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4624	002	0	1	02	01	H4624_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	002	0	1	02	01	H4624_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	002	0	1	02	01	H4624_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	002	0	1	02	01	H4624_002_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	002	0	1	02	01	H4624_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	002	0	1	02	01	H4624_002_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4624	003	0	1	01	01	H4624_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	003	0	1	01	01	H4624_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	003	0	1	01	01	H4624_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	003	0	1	01	01	H4624_003_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	003	0	1	01	01	H4624_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	003	0	1	01	01	H4624_003_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4624	004	0	1	01	01	H4624_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	004	0	1	01	01	H4624_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	004	0	1	01	01	H4624_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	004	0	1	01	01	H4624_004_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	004	0	1	01	01	H4624_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	004	0	1	01	01	H4624_004_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4624	005	0	1	01	01	H4624_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	005	0	1	01	01	H4624_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	005	0	1	01	01	H4624_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	005	0	1	01	01	H4624_005_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	005	0	1	01	01	H4624_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	005	0	1	01	01	H4624_005_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4624	006	0	1	01	01	H4624_006_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	006	0	1	01	01	H4624_006_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	006	0	1	01	01	H4624_006_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	006	0	1	01	01	H4624_006_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	006	0	1	01	01	H4624_006_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	006	0	1	01	01	H4624_006_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4624	007	0	1	02	01	H4624_007_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	007	0	1	02	01	H4624_007_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	007	0	1	02	01	H4624_007_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	007	0	1	02	01	H4624_007_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	007	0	1	02	01	H4624_007_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	007	0	1	02	01	H4624_007_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4624	010	0	1	01	01	H4624_010_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	010	0	1	01	01	H4624_010_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	010	0	1	01	01	H4624_010_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	010	0	1	01	01	H4624_010_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	010	0	1	01	01	H4624_010_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	010	0	1	01	01	H4624_010_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4624	011	0	1	01	01	H4624_011_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	011	0	1	01	01	H4624_011_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	011	0	1	01	01	H4624_011_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	011	0	1	01	01	H4624_011_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	011	0	1	01	01	H4624_011_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	011	0	1	01	01	H4624_011_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4624	012	0	1	01	01	H4624_012_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H4624	012	0	1	01	01	H4624_012_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H4624	012	0	1	01	01	H4624_012_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H4624	012	0	1	01	01	H4624_012_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H4624	012	0	1	01	01	H4624_012_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H4624	012	0	1	01	01	H4624_012_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H4675	001	0	1	01	01	H4675_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4675	001	0	1	01	01	H4675_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4675	001	0	1	01	01	H4675_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4675	001	0	1	01	01	H4675_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4675	001	0	1	01	01	H4675_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4676	001	0	1	01	01	H4676_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H4676	001	0	1	01	01	H4676_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H4676	001	0	1	01	01	H4676_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H4676	001	0	1	01	01	H4676_001_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H4676	001	0	1	01	01	H4676_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H4676	002	0	1	01	01	H4676_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	1						
H4676	002	0	1	01	01	H4676_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H4676	002	0	1	01	01	H4676_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H4676	002	0	1	01	01	H4676_002_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H4676	002	0	1	01	01	H4676_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H4699	001	0	1	04	01	H4699_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4699	001	0	1	04	01	H4699_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4699	001	0	1	04	01	H4699_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4699	001	0	1	04	01	H4699_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4699	001	0	1	04	01	H4699_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4699	002	0	1	04	01	H4699_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4699	002	0	1	04	01	H4699_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4699	002	0	1	04	01	H4699_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4699	002	0	1	04	01	H4699_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4699	002	0	1	04	01	H4699_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4699	003	0	1	04	01	H4699_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4699	003	0	1	04	01	H4699_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4699	003	0	1	04	01	H4699_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4699	003	0	1	04	01	H4699_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4699	003	0	1	04	01	H4699_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4709	001	0	1	01	01	H4709_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4709	001	0	1	01	01	H4709_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4709	001	0	1	01	01	H4709_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4709	001	0	1	01	01	H4709_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4709	001	0	1	01	01	H4709_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4709	001	0	1	01	01	H4709_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H4709	003	0	1	01	01	H4709_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4709	003	0	1	01	01	H4709_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4709	003	0	1	01	01	H4709_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4709	003	0	1	01	01	H4709_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4709	003	0	1	01	01	H4709_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4709	003	0	1	01	01	H4709_003_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H4709	011	0	1	01	01	H4709_011_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4709	011	0	1	01	01	H4709_011_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4709	011	0	1	01	01	H4709_011_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4709	011	0	1	01	01	H4709_011_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4709	011	0	1	01	01	H4709_011_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4709	011	0	1	01	01	H4709_011_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H4709	024	0	1	01	01	H4709_024_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4709	024	0	1	01	01	H4709_024_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4709	024	0	1	01	01	H4709_024_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4709	024	0	1	01	01	H4709_024_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4709	024	0	1	01	01	H4709_024_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4709	024	0	1	01	01	H4709_024_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H4709	025	0	1	01	01	H4709_025_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4709	025	0	1	01	01	H4709_025_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4709	025	0	1	01	01	H4709_025_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4709	025	0	1	01	01	H4709_025_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4709	025	0	1	01	01	H4709_025_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4709	025	0	1	01	01	H4709_025_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H4711	001	0	1	01	01	H4711_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4711	001	0	1	01	01	H4711_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4711	001	0	1	01	01	H4711_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4711	001	0	1	01	01	H4711_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4711	001	0	1	01	01	H4711_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4711	002	0	1	01	01	H4711_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4711	002	0	1	01	01	H4711_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4711	002	0	1	01	01	H4711_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4711	002	0	1	01	01	H4711_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4711	002	0	1	01	01	H4711_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4711	005	0	1	01	01	H4711_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4711	005	0	1	01	01	H4711_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4711	005	0	1	01	01	H4711_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4711	005	0	1	01	01	H4711_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4711	005	0	1	01	01	H4711_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4711	006	0	1	01	01	H4711_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4711	006	0	1	01	01	H4711_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4711	006	0	1	01	01	H4711_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4711	006	0	1	01	01	H4711_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4711	006	0	1	01	01	H4711_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4711	007	0	1	01	01	H4711_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4711	007	0	1	01	01	H4711_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4711	007	0	1	01	01	H4711_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4711	007	0	1	01	01	H4711_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4711	007	0	1	01	01	H4711_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4711	008	0	1	01	01	H4711_008_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4711	008	0	1	01	01	H4711_008_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4711	008	0	1	01	01	H4711_008_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4711	008	0	1	01	01	H4711_008_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4711	008	0	1	01	01	H4711_008_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4711	009	0	1	01	01	H4711_009_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4711	009	0	1	01	01	H4711_009_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4711	009	0	1	01	01	H4711_009_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4711	009	0	1	01	01	H4711_009_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4711	009	0	1	01	01	H4711_009_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4711	011	0	1	01	01	H4711_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4711	011	0	1	01	01	H4711_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4711	011	0	1	01	01	H4711_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4711	011	0	1	01	01	H4711_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4711	011	0	1	01	01	H4711_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4754	004	0	1	04	01	H4754_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4754	004	0	1	04	01	H4754_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4754	004	0	1	04	01	H4754_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H4754	004	0	1	04	01	H4754_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4754	004	0	1	04	01	H4754_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4754	004	0	1	04	01	H4754_004_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4754	007	0	1	04	01	H4754_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4754	007	0	1	04	01	H4754_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4754	007	0	1	04	01	H4754_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H4754	007	0	1	04	01	H4754_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4754	007	0	1	04	01	H4754_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4754	007	0	1	04	01	H4754_007_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4754	009	0	1	04	01	H4754_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4754	009	0	1	04	01	H4754_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4754	009	0	1	04	01	H4754_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H4754	009	0	1	04	01	H4754_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4754	009	0	1	04	01	H4754_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4754	009	0	1	04	01	H4754_009_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4754	011	0	1	04	01	H4754_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4754	011	0	1	04	01	H4754_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4754	011	0	1	04	01	H4754_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H4754	011	0	1	04	01	H4754_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4754	011	0	1	04	01	H4754_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4754	011	0	1	04	01	H4754_011_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4754	017	0	1	04	01	H4754_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4754	017	0	1	04	01	H4754_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4754	017	0	1	04	01	H4754_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H4754	017	0	1	04	01	H4754_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4754	017	0	1	04	01	H4754_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4754	017	0	1	04	01	H4754_017_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4829	002	0	1	04	01	H4829_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4829	002	0	1	04	01	H4829_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4829	002	0	1	04	01	H4829_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4829	002	0	1	04	01	H4829_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4829	002	0	1	04	01	H4829_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4829	003	0	1	04	01	H4829_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4829	003	0	1	04	01	H4829_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4829	003	0	1	04	01	H4829_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4829	003	0	1	04	01	H4829_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4829	003	0	1	04	01	H4829_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4829	004	0	1	04	01	H4829_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4829	004	0	1	04	01	H4829_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4829	004	0	1	04	01	H4829_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4829	004	0	1	04	01	H4829_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4829	004	0	1	04	01	H4829_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4835	001	0	1	01	01	H4835_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4835	001	0	1	01	01	H4835_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4835	001	0	1	01	01	H4835_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4835	001	0	1	01	01	H4835_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4835	001	0	1	01	01	H4835_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4835	002	0	1	01	01	H4835_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4835	002	0	1	01	01	H4835_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4835	002	0	1	01	01	H4835_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4835	002	0	1	01	01	H4835_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4835	002	0	1	01	01	H4835_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4835	003	0	1	01	01	H4835_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4835	003	0	1	01	01	H4835_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4835	003	0	1	01	01	H4835_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4835	003	0	1	01	01	H4835_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4835	003	0	1	01	01	H4835_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4835	004	0	1	01	01	H4835_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4835	004	0	1	01	01	H4835_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4835	004	0	1	01	01	H4835_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4835	004	0	1	01	01	H4835_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4835	004	0	1	01	01	H4835_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4835	005	0	1	01	01	H4835_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4835	005	0	1	01	01	H4835_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4835	005	0	1	01	01	H4835_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4835	005	0	1	01	01	H4835_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4835	005	0	1	01	01	H4835_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4835	006	0	1	01	01	H4835_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4835	006	0	1	01	01	H4835_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4835	006	0	1	01	01	H4835_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4835	006	0	1	01	01	H4835_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4835	006	0	1	01	01	H4835_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4847	001	0	1	01	01	H4847_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4847	001	0	1	01	01	H4847_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4847	001	0	1	01	01	H4847_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4847	001	0	1	01	01	H4847_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4847	001	0	1	01	01	H4847_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4847	002	0	1	01	01	H4847_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4847	002	0	1	01	01	H4847_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4847	002	0	1	01	01	H4847_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4847	002	0	1	01	01	H4847_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4847	002	0	1	01	01	H4847_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4847	003	0	1	01	01	H4847_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4847	003	0	1	01	01	H4847_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4847	003	0	1	01	01	H4847_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4847	003	0	1	01	01	H4847_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4847	003	0	1	01	01	H4847_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4847	004	0	1	01	01	H4847_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4847	004	0	1	01	01	H4847_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4847	004	0	1	01	01	H4847_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4847	004	0	1	01	01	H4847_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4847	004	0	1	01	01	H4847_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4847	005	0	1	01	01	H4847_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4847	005	0	1	01	01	H4847_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4847	005	0	1	01	01	H4847_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4847	005	0	1	01	01	H4847_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4847	005	0	1	01	01	H4847_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4853	001	0	1	01	01	H4853_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4853	001	0	1	01	01	H4853_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4853	001	0	1	01	01	H4853_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4853	001	0	1	01	01	H4853_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4853	001	0	1	01	01	H4853_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4853	001	0	1	01	01	H4853_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H4853	002	0	1	01	01	H4853_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4853	002	0	1	01	01	H4853_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4853	002	0	1	01	01	H4853_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4853	002	0	1	01	01	H4853_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4853	002	0	1	01	01	H4853_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4853	002	0	1	01	01	H4853_002_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H4853	014	0	1	01	01	H4853_014_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4853	014	0	1	01	01	H4853_014_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H4853	014	0	1	01	01	H4853_014_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4853	014	0	1	01	01	H4853_014_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4853	014	0	1	01	01	H4853_014_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4853	014	0	1	01	01	H4853_014_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H4868	002	0	1	01	01	H4868_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4868	002	0	1	01	01	H4868_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4868	002	0	1	01	01	H4868_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4868	002	0	1	01	01	H4868_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4868	002	0	1	01	01	H4868_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4868	004	0	1	01	01	H4868_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4868	004	0	1	01	01	H4868_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4868	004	0	1	01	01	H4868_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4868	004	0	1	01	01	H4868_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4868	004	0	1	01	01	H4868_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4868	010	0	1	01	01	H4868_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4868	010	0	1	01	01	H4868_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4868	010	0	1	01	01	H4868_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4868	010	0	1	01	01	H4868_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4868	010	0	1	01	01	H4868_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4868	014	0	1	01	01	H4868_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4868	014	0	1	01	01	H4868_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4868	014	0	1	01	01	H4868_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4868	014	0	1	01	01	H4868_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4868	014	0	1	01	01	H4868_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4868	016	0	1	01	01	H4868_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4868	016	0	1	01	01	H4868_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4868	016	0	1	01	01	H4868_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4868	016	0	1	01	01	H4868_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4868	016	0	1	01	01	H4868_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4868	018	0	1	01	01	H4868_018_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4868	018	0	1	01	01	H4868_018_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4868	018	0	1	01	01	H4868_018_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4868	018	0	1	01	01	H4868_018_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4868	018	0	1	01	01	H4868_018_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4868	019	0	1	01	01	H4868_019_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4868	019	0	1	01	01	H4868_019_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4868	019	0	1	01	01	H4868_019_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4868	019	0	1	01	01	H4868_019_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4868	019	0	1	01	01	H4868_019_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4868	020	0	1	01	01	H4868_020_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4868	020	0	1	01	01	H4868_020_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4868	020	0	1	01	01	H4868_020_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4868	020	0	1	01	01	H4868_020_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4868	020	0	1	01	01	H4868_020_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4868	022	0	1	01	01	H4868_022_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H4868	022	0	1	01	01	H4868_022_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4868	022	0	1	01	01	H4868_022_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4868	022	0	1	01	01	H4868_022_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4868	022	0	1	01	01	H4868_022_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	016	1	1	04	01	H4875_016_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	016	1	1	04	01	H4875_016_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	016	1	1	04	01	H4875_016_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	016	1	1	04	01	H4875_016_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	016	1	1	04	01	H4875_016_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	016	2	1	04	01	H4875_016_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	016	2	1	04	01	H4875_016_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	016	2	1	04	01	H4875_016_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	016	2	1	04	01	H4875_016_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	016	2	1	04	01	H4875_016_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	016	3	1	04	01	H4875_016_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	016	3	1	04	01	H4875_016_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	016	3	1	04	01	H4875_016_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	016	3	1	04	01	H4875_016_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	016	3	1	04	01	H4875_016_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	016	4	1	04	01	H4875_016_4	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	016	4	1	04	01	H4875_016_4	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	016	4	1	04	01	H4875_016_4	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	016	4	1	04	01	H4875_016_4	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	016	4	1	04	01	H4875_016_4	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	016	5	1	04	01	H4875_016_5	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	016	5	1	04	01	H4875_016_5	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	016	5	1	04	01	H4875_016_5	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	016	5	1	04	01	H4875_016_5	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	016	5	1	04	01	H4875_016_5	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	017	1	1	04	01	H4875_017_1	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	017	1	1	04	01	H4875_017_1	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	017	1	1	04	01	H4875_017_1	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	017	1	1	04	01	H4875_017_1	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	017	1	1	04	01	H4875_017_1	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	017	2	1	04	01	H4875_017_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	017	2	1	04	01	H4875_017_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	017	2	1	04	01	H4875_017_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	017	2	1	04	01	H4875_017_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	017	2	1	04	01	H4875_017_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	017	3	1	04	01	H4875_017_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	017	3	1	04	01	H4875_017_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	017	3	1	04	01	H4875_017_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	017	3	1	04	01	H4875_017_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	017	3	1	04	01	H4875_017_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	017	4	1	04	01	H4875_017_4	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	017	4	1	04	01	H4875_017_4	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	017	4	1	04	01	H4875_017_4	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	017	4	1	04	01	H4875_017_4	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	017	4	1	04	01	H4875_017_4	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	017	5	1	04	01	H4875_017_5	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	017	5	1	04	01	H4875_017_5	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	017	5	1	04	01	H4875_017_5	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	017	5	1	04	01	H4875_017_5	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	017	5	1	04	01	H4875_017_5	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	018	1	1	04	01	H4875_018_1	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	018	1	1	04	01	H4875_018_1	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	018	1	1	04	01	H4875_018_1	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	018	1	1	04	01	H4875_018_1	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	018	1	1	04	01	H4875_018_1	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	018	2	1	04	01	H4875_018_2	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	018	2	1	04	01	H4875_018_2	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	018	2	1	04	01	H4875_018_2	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	018	2	1	04	01	H4875_018_2	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	018	2	1	04	01	H4875_018_2	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	018	3	1	04	01	H4875_018_3	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	018	3	1	04	01	H4875_018_3	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	018	3	1	04	01	H4875_018_3	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	018	3	1	04	01	H4875_018_3	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	018	3	1	04	01	H4875_018_3	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	018	4	1	04	01	H4875_018_4	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	018	4	1	04	01	H4875_018_4	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	018	4	1	04	01	H4875_018_4	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	018	4	1	04	01	H4875_018_4	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	018	4	1	04	01	H4875_018_4	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	018	5	1	04	01	H4875_018_5	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	018	5	1	04	01	H4875_018_5	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	018	5	1	04	01	H4875_018_5	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	018	5	1	04	01	H4875_018_5	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	018	5	1	04	01	H4875_018_5	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	020	1	1	04	01	H4875_020_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	020	1	1	04	01	H4875_020_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	020	1	1	04	01	H4875_020_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	020	1	1	04	01	H4875_020_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	020	1	1	04	01	H4875_020_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	020	2	1	04	01	H4875_020_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	020	2	1	04	01	H4875_020_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	020	2	1	04	01	H4875_020_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	020	2	1	04	01	H4875_020_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	020	2	1	04	01	H4875_020_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	020	3	1	04	01	H4875_020_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	020	3	1	04	01	H4875_020_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	020	3	1	04	01	H4875_020_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	020	3	1	04	01	H4875_020_3	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	020	3	1	04	01	H4875_020_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	021	1	1	04	01	H4875_021_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	021	1	1	04	01	H4875_021_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	021	1	1	04	01	H4875_021_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	021	1	1	04	01	H4875_021_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	021	1	1	04	01	H4875_021_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	021	2	1	04	01	H4875_021_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	021	2	1	04	01	H4875_021_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	021	2	1	04	01	H4875_021_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	021	2	1	04	01	H4875_021_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	021	2	1	04	01	H4875_021_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	022	1	1	04	01	H4875_022_1	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	022	1	1	04	01	H4875_022_1	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	022	1	1	04	01	H4875_022_1	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	022	1	1	04	01	H4875_022_1	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	022	1	1	04	01	H4875_022_1	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	022	2	1	04	01	H4875_022_2	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	022	2	1	04	01	H4875_022_2	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	022	2	1	04	01	H4875_022_2	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	022	2	1	04	01	H4875_022_2	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	022	2	1	04	01	H4875_022_2	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4875	022	5	1	04	01	H4875_022_5	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4875	022	5	1	04	01	H4875_022_5	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H4875	022	5	1	04	01	H4875_022_5	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4875	022	5	1	04	01	H4875_022_5	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4875	022	5	1	04	01	H4875_022_5	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4882	001	0	1	04	01	H4882_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4882	001	0	1	04	01	H4882_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4882	001	0	1	04	01	H4882_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4882	001	0	1	04	01	H4882_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4882	001	0	1	04	01	H4882_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4882	002	0	1	04	01	H4882_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4882	002	0	1	04	01	H4882_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4882	002	0	1	04	01	H4882_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4882	002	0	1	04	01	H4882_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4882	002	0	1	04	01	H4882_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4882	003	0	1	04	01	H4882_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4882	003	0	1	04	01	H4882_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4882	003	0	1	04	01	H4882_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4882	003	0	1	04	01	H4882_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4882	003	0	1	04	01	H4882_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4882	004	0	1	04	01	H4882_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4882	004	0	1	04	01	H4882_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4882	004	0	1	04	01	H4882_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4882	004	0	1	04	01	H4882_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4882	004	0	1	04	01	H4882_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4882	005	0	1	04	01	H4882_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4882	005	0	1	04	01	H4882_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4882	005	0	1	04	01	H4882_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4882	005	0	1	04	01	H4882_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4882	005	0	1	04	01	H4882_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4882	006	0	1	04	01	H4882_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4882	006	0	1	04	01	H4882_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4882	006	0	1	04	01	H4882_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4882	006	0	1	04	01	H4882_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4882	006	0	1	04	01	H4882_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4909	014	0	1	04	01	H4909_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4909	014	0	1	04	01	H4909_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4909	014	0	1	04	01	H4909_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4909	014	0	1	04	01	H4909_014_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4909	014	0	1	04	01	H4909_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4909	014	0	1	04	01	H4909_014_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4909	015	0	1	04	01	H4909_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4909	015	0	1	04	01	H4909_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4909	015	0	1	04	01	H4909_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4909	015	0	1	04	01	H4909_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4909	015	0	1	04	01	H4909_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4909	015	0	1	04	01	H4909_015_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4909	016	0	1	04	01	H4909_016_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4909	016	0	1	04	01	H4909_016_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4909	016	0	1	04	01	H4909_016_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4909	016	0	1	04	01	H4909_016_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4909	016	0	1	04	01	H4909_016_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4909	016	0	1	04	01	H4909_016_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4909	018	0	1	04	01	H4909_018_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H4909	018	0	1	04	01	H4909_018_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H4909	018	0	1	04	01	H4909_018_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4909	018	0	1	04	01	H4909_018_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H4909	018	0	1	04	01	H4909_018_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4909	018	0	1	04	01	H4909_018_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4922	011	0	1	01	01	H4922_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4922	011	0	1	01	01	H4922_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4922	011	0	1	01	01	H4922_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H4922	011	0	1	01	01	H4922_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H4922	011	0	1	01	01	H4922_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4937	001	0	1	04	01	H4937_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4937	001	0	1	04	01	H4937_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4937	001	0	1	04	01	H4937_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4937	001	0	1	04	01	H4937_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4937	001	0	1	04	01	H4937_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4961	001	0	1	04	01	H4961_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4961	001	0	1	04	01	H4961_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H4961	001	0	1	04	01	H4961_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4961	001	0	1	04	01	H4961_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H4961	001	0	1	04	01	H4961_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4961	001	0	1	04	01	H4961_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4961	002	0	1	04	01	H4961_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4961	002	0	1	04	01	H4961_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H4961	002	0	1	04	01	H4961_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4961	002	0	1	04	01	H4961_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H4961	002	0	1	04	01	H4961_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4961	002	0	1	04	01	H4961_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4961	003	0	1	04	01	H4961_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4961	003	0	1	04	01	H4961_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H4961	003	0	1	04	01	H4961_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4961	003	0	1	04	01	H4961_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H4961	003	0	1	04	01	H4961_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4961	003	0	1	04	01	H4961_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4961	004	0	1	04	01	H4961_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4961	004	0	1	04	01	H4961_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H4961	004	0	1	04	01	H4961_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4961	004	0	1	04	01	H4961_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H4961	004	0	1	04	01	H4961_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4961	004	0	1	04	01	H4961_004_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4961	006	0	1	04	01	H4961_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H4961	006	0	1	04	01	H4961_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H4961	006	0	1	04	01	H4961_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H4961	006	0	1	04	01	H4961_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H4961	006	0	1	04	01	H4961_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H4961	006	0	1	04	01	H4961_006_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H4982	001	0	1	01	01	H4982_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	001	0	1	01	01	H4982_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	001	0	1	01	01	H4982_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	001	0	1	01	01	H4982_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	001	0	1	01	01	H4982_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	002	0	1	01	01	H4982_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	002	0	1	01	01	H4982_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	002	0	1	01	01	H4982_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	002	0	1	01	01	H4982_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	002	0	1	01	01	H4982_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	003	0	1	01	01	H4982_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	003	0	1	01	01	H4982_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	003	0	1	01	01	H4982_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	003	0	1	01	01	H4982_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	003	0	1	01	01	H4982_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	004	0	1	01	01	H4982_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	004	0	1	01	01	H4982_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	004	0	1	01	01	H4982_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	004	0	1	01	01	H4982_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	004	0	1	01	01	H4982_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	005	0	1	01	01	H4982_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	005	0	1	01	01	H4982_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	005	0	1	01	01	H4982_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	005	0	1	01	01	H4982_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	005	0	1	01	01	H4982_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	006	0	1	01	01	H4982_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	006	0	1	01	01	H4982_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	006	0	1	01	01	H4982_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	006	0	1	01	01	H4982_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	006	0	1	01	01	H4982_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	007	0	1	01	01	H4982_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	007	0	1	01	01	H4982_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	007	0	1	01	01	H4982_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	007	0	1	01	01	H4982_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	007	0	1	01	01	H4982_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	008	0	1	01	01	H4982_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4982	008	0	1	01	01	H4982_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4982	008	0	1	01	01	H4982_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	008	0	1	01	01	H4982_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	008	0	1	01	01	H4982_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	009	0	1	01	01	H4982_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4982	009	0	1	01	01	H4982_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4982	009	0	1	01	01	H4982_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	009	0	1	01	01	H4982_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	009	0	1	01	01	H4982_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	010	0	1	01	01	H4982_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	010	0	1	01	01	H4982_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	010	0	1	01	01	H4982_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	010	0	1	01	01	H4982_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	010	0	1	01	01	H4982_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	011	0	1	01	01	H4982_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	011	0	1	01	01	H4982_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	011	0	1	01	01	H4982_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	011	0	1	01	01	H4982_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	011	0	1	01	01	H4982_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	012	0	1	01	01	H4982_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H4982	012	0	1	01	01	H4982_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H4982	012	0	1	01	01	H4982_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	012	0	1	01	01	H4982_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	012	0	1	01	01	H4982_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H4982	015	0	1	01	01	H4982_015_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H4982	015	0	1	01	01	H4982_015_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H4982	015	0	1	01	01	H4982_015_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H4982	015	0	1	01	01	H4982_015_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H4982	015	0	1	01	01	H4982_015_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5009	002	0	1	04	01	H5009_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5009	002	0	1	04	01	H5009_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5009	002	0	1	04	01	H5009_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5009	002	0	1	04	01	H5009_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5009	002	0	1	04	01	H5009_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5009	008	0	1	04	01	H5009_008_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5009	008	0	1	04	01	H5009_008_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5009	008	0	1	04	01	H5009_008_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5009	008	0	1	04	01	H5009_008_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5009	008	0	1	04	01	H5009_008_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5009	009	0	1	04	01	H5009_009_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5009	009	0	1	04	01	H5009_009_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5009	009	0	1	04	01	H5009_009_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5009	009	0	1	04	01	H5009_009_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5009	009	0	1	04	01	H5009_009_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5010	002	0	1	04	01	H5010_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5010	002	0	1	04	01	H5010_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5010	002	0	1	04	01	H5010_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5010	002	0	1	04	01	H5010_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5010	002	0	1	04	01	H5010_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5010	004	0	1	04	01	H5010_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5010	004	0	1	04	01	H5010_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5010	004	0	1	04	01	H5010_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5010	004	0	1	04	01	H5010_004_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5010	004	0	1	04	01	H5010_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5010	007	0	1	04	01	H5010_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5010	007	0	1	04	01	H5010_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5010	007	0	1	04	01	H5010_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5010	007	0	1	04	01	H5010_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5010	007	0	1	04	01	H5010_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5042	009	0	1	04	01	H5042_009_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5042	009	0	1	04	01	H5042_009_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5042	009	0	1	04	01	H5042_009_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5042	009	0	1	04	01	H5042_009_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5042	009	0	1	04	01	H5042_009_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5042	011	0	1	04	01	H5042_011_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5042	011	0	1	04	01	H5042_011_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5042	011	0	1	04	01	H5042_011_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5042	011	0	1	04	01	H5042_011_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5042	011	0	1	04	01	H5042_011_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5050	004	0	1	01	01	H5050_004_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H5050	004	0	1	01	01	H5050_004_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H5050	004	0	1	01	01	H5050_004_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H5050	004	0	1	01	01	H5050_004_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H5050	004	0	1	01	01	H5050_004_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H5050	004	0	1	01	01	H5050_004_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H5050	009	0	1	01	01	H5050_009_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H5050	009	0	1	01	01	H5050_009_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H5050	009	0	1	01	01	H5050_009_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H5050	009	0	1	01	01	H5050_009_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H5050	009	0	1	01	01	H5050_009_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H5050	009	0	1	01	01	H5050_009_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H5050	013	0	1	01	01	H5050_013_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H5050	013	0	1	01	01	H5050_013_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H5050	013	0	1	01	01	H5050_013_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H5050	013	0	1	01	01	H5050_013_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H5050	013	0	1	01	01	H5050_013_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H5050	013	0	1	01	01	H5050_013_0	10	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H5050	017	0	1	01	01	H5050_017_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H5050	017	0	1	01	01	H5050_017_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H5050	017	0	1	01	01	H5050_017_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H5050	017	0	1	01	01	H5050_017_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H5050	017	0	1	01	01	H5050_017_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H5050	017	0	1	01	01	H5050_017_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H5050	019	0	1	01	01	H5050_019_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H5050	019	0	1	01	01	H5050_019_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H5050	019	0	1	01	01	H5050_019_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H5050	019	0	1	01	01	H5050_019_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H5050	019	0	1	01	01	H5050_019_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H5050	019	0	1	01	01	H5050_019_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H5050	021	0	1	01	01	H5050_021_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H5050	021	0	1	01	01	H5050_021_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H5050	021	0	1	01	01	H5050_021_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H5050	021	0	1	01	01	H5050_021_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H5050	021	0	1	01	01	H5050_021_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H5050	021	0	1	01	01	H5050_021_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H5050	022	0	1	01	01	H5050_022_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H5050	022	0	1	01	01	H5050_022_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H5050	022	0	1	01	01	H5050_022_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H5050	022	0	1	01	01	H5050_022_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H5050	022	0	1	01	01	H5050_022_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H5050	022	0	1	01	01	H5050_022_0	12	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H5050	023	0	1	01	01	H5050_023_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H5050	023	0	1	01	01	H5050_023_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1						
H5050	023	0	1	01	01	H5050_023_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1						
H5050	023	0	1	01	01	H5050_023_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H5050	023	0	1	01	01	H5050_023_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H5050	023	0	1	01	01	H5050_023_0	11	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1						
H5087	001	0	1	01	01	H5087_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5087	001	0	1	01	01	H5087_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5087	001	0	1	01	01	H5087_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5087	001	0	1	01	01	H5087_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5087	001	0	1	01	01	H5087_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5087	002	0	1	01	01	H5087_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5087	002	0	1	01	01	H5087_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5087	002	0	1	01	01	H5087_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5087	002	0	1	01	01	H5087_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5087	002	0	1	01	01	H5087_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5087	005	0	1	01	01	H5087_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5087	005	0	1	01	01	H5087_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5087	005	0	1	01	01	H5087_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5087	005	0	1	01	01	H5087_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5087	005	0	1	01	01	H5087_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5087	016	0	1	01	01	H5087_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5087	016	0	1	01	01	H5087_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5087	016	0	1	01	01	H5087_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5087	016	0	1	01	01	H5087_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5087	016	0	1	01	01	H5087_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5087	017	0	1	01	01	H5087_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5087	017	0	1	01	01	H5087_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5087	017	0	1	01	01	H5087_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5087	017	0	1	01	01	H5087_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5087	017	0	1	01	01	H5087_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5087	024	0	1	01	01	H5087_024_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5087	024	0	1	01	01	H5087_024_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5087	024	0	1	01	01	H5087_024_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5087	024	0	1	01	01	H5087_024_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5087	024	0	1	01	01	H5087_024_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5087	025	0	1	01	01	H5087_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5087	025	0	1	01	01	H5087_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5087	025	0	1	01	01	H5087_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5087	025	0	1	01	01	H5087_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5087	025	0	1	01	01	H5087_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5087	026	0	1	01	01	H5087_026_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5087	026	0	1	01	01	H5087_026_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5087	026	0	1	01	01	H5087_026_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5087	026	0	1	01	01	H5087_026_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5087	026	0	1	01	01	H5087_026_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5106	013	0	1	04	01	H5106_013_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5106	013	0	1	04	01	H5106_013_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5106	013	0	1	04	01	H5106_013_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5106	013	0	1	04	01	H5106_013_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5106	013	0	1	04	01	H5106_013_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5106	029	1	1	04	01	H5106_029_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5106	029	1	1	04	01	H5106_029_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5106	029	1	1	04	01	H5106_029_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5106	029	1	1	04	01	H5106_029_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5106	029	1	1	04	01	H5106_029_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5106	029	2	1	04	01	H5106_029_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5106	029	2	1	04	01	H5106_029_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5106	029	2	1	04	01	H5106_029_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5106	029	2	1	04	01	H5106_029_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5106	029	2	1	04	01	H5106_029_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5117	003	0	1	01	01	H5117_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5117	003	0	1	01	01	H5117_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5117	003	0	1	01	01	H5117_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5117	003	0	1	01	01	H5117_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5117	003	0	1	01	01	H5117_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5117	003	0	1	01	01	H5117_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5117	004	0	1	01	01	H5117_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5117	004	0	1	01	01	H5117_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5117	004	0	1	01	01	H5117_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5117	004	0	1	01	01	H5117_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5117	004	0	1	01	01	H5117_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5117	005	0	1	01	01	H5117_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5117	005	0	1	01	01	H5117_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5117	005	0	1	01	01	H5117_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5117	005	0	1	01	01	H5117_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5117	005	0	1	01	01	H5117_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5126	001	0	1	01	01	H5126_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5126	001	0	1	01	01	H5126_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5126	001	0	1	01	01	H5126_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5126	001	0	1	01	01	H5126_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5126	001	0	1	01	01	H5126_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5140	001	0	1	04	01	H5140_001_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5140	001	0	1	04	01	H5140_001_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5140	001	0	1	04	01	H5140_001_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5140	001	0	1	04	01	H5140_001_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5140	001	0	1	04	01	H5140_001_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5140	002	0	1	04	01	H5140_002_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5140	002	0	1	04	01	H5140_002_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5140	002	0	1	04	01	H5140_002_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5140	002	0	1	04	01	H5140_002_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5140	002	0	1	04	01	H5140_002_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5141	001	0	1	04	01	H5141_001_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	001	0	1	04	01	H5141_001_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	001	0	1	04	01	H5141_001_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	001	0	1	04	01	H5141_001_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	001	0	1	04	01	H5141_001_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	004	0	1	04	01	H5141_004_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	004	0	1	04	01	H5141_004_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	004	0	1	04	01	H5141_004_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	004	0	1	04	01	H5141_004_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	004	0	1	04	01	H5141_004_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	007	0	1	04	01	H5141_007_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	007	0	1	04	01	H5141_007_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	007	0	1	04	01	H5141_007_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	007	0	1	04	01	H5141_007_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	007	0	1	04	01	H5141_007_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	025	0	1	04	01	H5141_025_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	025	0	1	04	01	H5141_025_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	025	0	1	04	01	H5141_025_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	025	0	1	04	01	H5141_025_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	025	0	1	04	01	H5141_025_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	026	0	1	04	01	H5141_026_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	026	0	1	04	01	H5141_026_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	026	0	1	04	01	H5141_026_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	026	0	1	04	01	H5141_026_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	026	0	1	04	01	H5141_026_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	032	0	1	04	01	H5141_032_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	032	0	1	04	01	H5141_032_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	032	0	1	04	01	H5141_032_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	032	0	1	04	01	H5141_032_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	032	0	1	04	01	H5141_032_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	033	0	1	04	01	H5141_033_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	033	0	1	04	01	H5141_033_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	033	0	1	04	01	H5141_033_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	033	0	1	04	01	H5141_033_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	033	0	1	04	01	H5141_033_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	034	0	1	04	01	H5141_034_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	034	0	1	04	01	H5141_034_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	034	0	1	04	01	H5141_034_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	034	0	1	04	01	H5141_034_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	034	0	1	04	01	H5141_034_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	035	0	1	04	01	H5141_035_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	035	0	1	04	01	H5141_035_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	035	0	1	04	01	H5141_035_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	035	0	1	04	01	H5141_035_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	035	0	1	04	01	H5141_035_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	036	0	1	04	01	H5141_036_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	036	0	1	04	01	H5141_036_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	036	0	1	04	01	H5141_036_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	036	0	1	04	01	H5141_036_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	036	0	1	04	01	H5141_036_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	037	0	1	04	01	H5141_037_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	037	0	1	04	01	H5141_037_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	037	0	1	04	01	H5141_037_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	037	0	1	04	01	H5141_037_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	037	0	1	04	01	H5141_037_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	038	0	1	04	01	H5141_038_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	038	0	1	04	01	H5141_038_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	038	0	1	04	01	H5141_038_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	038	0	1	04	01	H5141_038_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	038	0	1	04	01	H5141_038_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	039	0	1	04	01	H5141_039_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	039	0	1	04	01	H5141_039_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	039	0	1	04	01	H5141_039_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	039	0	1	04	01	H5141_039_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	039	0	1	04	01	H5141_039_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	040	0	1	04	01	H5141_040_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	040	0	1	04	01	H5141_040_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	040	0	1	04	01	H5141_040_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	040	0	1	04	01	H5141_040_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	040	0	1	04	01	H5141_040_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	042	0	1	04	01	H5141_042_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	042	0	1	04	01	H5141_042_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	042	0	1	04	01	H5141_042_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	042	0	1	04	01	H5141_042_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	042	0	1	04	01	H5141_042_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	045	0	1	04	01	H5141_045_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	045	0	1	04	01	H5141_045_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	045	0	1	04	01	H5141_045_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	045	0	1	04	01	H5141_045_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	045	0	1	04	01	H5141_045_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	046	0	1	04	01	H5141_046_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	046	0	1	04	01	H5141_046_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	046	0	1	04	01	H5141_046_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	046	0	1	04	01	H5141_046_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	046	0	1	04	01	H5141_046_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	047	0	1	04	01	H5141_047_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	047	0	1	04	01	H5141_047_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	047	0	1	04	01	H5141_047_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	047	0	1	04	01	H5141_047_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	047	0	1	04	01	H5141_047_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	048	0	1	04	01	H5141_048_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	048	0	1	04	01	H5141_048_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	048	0	1	04	01	H5141_048_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	048	0	1	04	01	H5141_048_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	048	0	1	04	01	H5141_048_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	049	0	1	04	01	H5141_049_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	049	0	1	04	01	H5141_049_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	049	0	1	04	01	H5141_049_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	049	0	1	04	01	H5141_049_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	049	0	1	04	01	H5141_049_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	050	0	1	04	01	H5141_050_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	050	0	1	04	01	H5141_050_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	050	0	1	04	01	H5141_050_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	050	0	1	04	01	H5141_050_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	050	0	1	04	01	H5141_050_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5141	051	0	1	04	01	H5141_051_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5141	051	0	1	04	01	H5141_051_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5141	051	0	1	04	01	H5141_051_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5141	051	0	1	04	01	H5141_051_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5141	051	0	1	04	01	H5141_051_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5172	002	0	1	48	05	H5172_002_0	10	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	2	01					1	0.00	0.00
H5172	002	0	1	48	05	H5172_002_0	10	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	2	10					1	0.00	0.00
H5172	002	0	1	48	05	H5172_002_0	10	Non-Medicare Rx Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	3	2	01					2	0.00	0.00
H5172	002	0	1	48	05	H5172_002_0	10	Non-Medicare OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	4	2	01					2	0.00	0.00
H5190	001	0	1	01	01	H5190_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5190	001	0	1	01	01	H5190_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5190	001	0	1	01	01	H5190_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5190	001	0	1	01	01	H5190_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5190	001	0	1	01	01	H5190_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5190	002	0	1	01	01	H5190_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5190	002	0	1	01	01	H5190_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5190	002	0	1	01	01	H5190_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5190	002	0	1	01	01	H5190_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5190	002	0	1	01	01	H5190_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5190	003	0	1	01	01	H5190_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5190	003	0	1	01	01	H5190_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5190	003	0	1	01	01	H5190_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5190	003	0	1	01	01	H5190_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5190	003	0	1	01	01	H5190_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5190	004	0	1	01	01	H5190_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5190	004	0	1	01	01	H5190_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5190	004	0	1	01	01	H5190_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5190	004	0	1	01	01	H5190_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5190	004	0	1	01	01	H5190_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5190	005	0	1	01	01	H5190_005_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5190	005	0	1	01	01	H5190_005_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5190	005	0	1	01	01	H5190_005_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5190	005	0	1	01	01	H5190_005_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5190	005	0	1	01	01	H5190_005_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5190	006	0	1	01	01	H5190_006_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5190	006	0	1	01	01	H5190_006_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5190	006	0	1	01	01	H5190_006_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5190	006	0	1	01	01	H5190_006_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5190	006	0	1	01	01	H5190_006_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5199	007	0	1	04	01	H5199_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5199	007	0	1	04	01	H5199_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5199	007	0	1	04	01	H5199_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5199	007	0	1	04	01	H5199_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5199	007	0	1	04	01	H5199_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5199	008	0	1	04	01	H5199_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5199	008	0	1	04	01	H5199_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5199	008	0	1	04	01	H5199_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5199	008	0	1	04	01	H5199_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5199	008	0	1	04	01	H5199_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5199	010	0	1	04	01	H5199_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5199	010	0	1	04	01	H5199_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5199	010	0	1	04	01	H5199_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5199	010	0	1	04	01	H5199_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5199	010	0	1	04	01	H5199_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5199	012	0	1	04	01	H5199_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5199	012	0	1	04	01	H5199_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5199	012	0	1	04	01	H5199_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5199	012	0	1	04	01	H5199_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5199	012	0	1	04	01	H5199_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5199	013	0	1	04	01	H5199_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5199	013	0	1	04	01	H5199_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5199	013	0	1	04	01	H5199_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5199	013	0	1	04	01	H5199_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5199	013	0	1	04	01	H5199_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5199	014	0	1	04	01	H5199_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5199	014	0	1	04	01	H5199_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5199	014	0	1	04	01	H5199_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5199	014	0	1	04	01	H5199_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5199	014	0	1	04	01	H5199_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5199	015	0	1	04	01	H5199_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5199	015	0	1	04	01	H5199_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5199	015	0	1	04	01	H5199_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5199	015	0	1	04	01	H5199_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5199	015	0	1	04	01	H5199_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5211	002	0	1	02	01	H5211_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	11	1						
H5211	002	0	1	02	01	H5211_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	11	1						
H5211	002	0	1	02	01	H5211_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5211	002	0	1	02	01	H5211_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5211	002	0	1	02	01	H5211_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5211	002	0	1	02	01	H5211_002_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5211	004	0	1	02	01	H5211_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	11	1						
H5211	004	0	1	02	01	H5211_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	11	1						
H5211	004	0	1	02	01	H5211_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5211	004	0	1	02	01	H5211_004_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5211	004	0	1	02	01	H5211_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5211	004	0	1	02	01	H5211_004_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5211	007	0	1	02	01	H5211_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	11	1						
H5211	007	0	1	02	01	H5211_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	11	1						
H5211	007	0	1	02	01	H5211_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5211	007	0	1	02	01	H5211_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5211	007	0	1	02	01	H5211_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5211	007	0	1	02	01	H5211_007_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5211	008	0	1	02	01	H5211_008_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	11	1						
H5211	008	0	1	02	01	H5211_008_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	11	1						
H5211	008	0	1	02	01	H5211_008_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5211	008	0	1	02	01	H5211_008_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5211	008	0	1	02	01	H5211_008_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5211	008	0	1	02	01	H5211_008_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5211	009	0	1	02	01	H5211_009_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	11	1						
H5211	009	0	1	02	01	H5211_009_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	11	1						
H5211	009	0	1	02	01	H5211_009_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5211	009	0	1	02	01	H5211_009_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5211	009	0	1	02	01	H5211_009_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5211	009	0	1	02	01	H5211_009_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5211	012	0	1	02	01	H5211_012_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	11	1						
H5211	012	0	1	02	01	H5211_012_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	11	1						
H5211	012	0	1	02	01	H5211_012_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5211	012	0	1	02	01	H5211_012_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5211	012	0	1	02	01	H5211_012_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5211	012	0	1	02	01	H5211_012_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5211	013	0	1	02	01	H5211_013_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	11	1						
H5211	013	0	1	02	01	H5211_013_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	11	1						
H5211	013	0	1	02	01	H5211_013_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5211	013	0	1	02	01	H5211_013_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5211	013	0	1	02	01	H5211_013_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5211	013	0	1	02	01	H5211_013_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5215	002	0	1	04	01	H5215_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5215	002	0	1	04	01	H5215_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5215	002	0	1	04	01	H5215_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H5215	002	0	1	04	01	H5215_002_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H5215	002	0	1	04	01	H5215_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5215	005	0	1	04	01	H5215_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5215	005	0	1	04	01	H5215_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5215	005	0	1	04	01	H5215_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H5215	005	0	1	04	01	H5215_005_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H5215	005	0	1	04	01	H5215_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5215	007	0	1	04	01	H5215_007_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5215	007	0	1	04	01	H5215_007_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5215	007	0	1	04	01	H5215_007_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H5215	007	0	1	04	01	H5215_007_0	7	Non-Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H5215	007	0	1	04	01	H5215_007_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5215	008	0	1	04	01	H5215_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5215	008	0	1	04	01	H5215_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5215	008	0	1	04	01	H5215_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H5215	008	0	1	04	01	H5215_008_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H5215	008	0	1	04	01	H5215_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5215	009	0	1	04	01	H5215_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5215	009	0	1	04	01	H5215_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5215	009	0	1	04	01	H5215_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H5215	009	0	1	04	01	H5215_009_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H5215	009	0	1	04	01	H5215_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5215	010	0	1	04	01	H5215_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5215	010	0	1	04	01	H5215_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5215	010	0	1	04	01	H5215_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H5215	010	0	1	04	01	H5215_010_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H5215	010	0	1	04	01	H5215_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5215	011	0	1	04	01	H5215_011_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5215	011	0	1	04	01	H5215_011_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5215	011	0	1	04	01	H5215_011_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H5215	011	0	1	04	01	H5215_011_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H5215	011	0	1	04	01	H5215_011_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5216	001	0	1	04	01	H5216_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	001	0	1	04	01	H5216_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	001	0	1	04	01	H5216_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	001	0	1	04	01	H5216_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	001	0	1	04	01	H5216_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	006	0	1	04	01	H5216_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	006	0	1	04	01	H5216_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	006	0	1	04	01	H5216_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	006	0	1	04	01	H5216_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	006	0	1	04	01	H5216_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	009	0	1	04	01	H5216_009_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	009	0	1	04	01	H5216_009_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	009	0	1	04	01	H5216_009_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	009	0	1	04	01	H5216_009_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	009	0	1	04	01	H5216_009_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	011	0	1	04	01	H5216_011_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	011	0	1	04	01	H5216_011_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	011	0	1	04	01	H5216_011_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	011	0	1	04	01	H5216_011_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	011	0	1	04	01	H5216_011_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	013	0	1	04	01	H5216_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	013	0	1	04	01	H5216_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	013	0	1	04	01	H5216_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	013	0	1	04	01	H5216_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	013	0	1	04	01	H5216_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	014	0	1	04	01	H5216_014_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	014	0	1	04	01	H5216_014_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	014	0	1	04	01	H5216_014_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	014	0	1	04	01	H5216_014_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	014	0	1	04	01	H5216_014_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	017	0	1	04	01	H5216_017_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	017	0	1	04	01	H5216_017_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	017	0	1	04	01	H5216_017_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	017	0	1	04	01	H5216_017_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	017	0	1	04	01	H5216_017_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	018	0	1	04	01	H5216_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	018	0	1	04	01	H5216_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	018	0	1	04	01	H5216_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	018	0	1	04	01	H5216_018_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	018	0	1	04	01	H5216_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	019	0	1	04	01	H5216_019_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	019	0	1	04	01	H5216_019_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	019	0	1	04	01	H5216_019_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	019	0	1	04	01	H5216_019_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	019	0	1	04	01	H5216_019_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	021	0	1	04	01	H5216_021_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	021	0	1	04	01	H5216_021_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	021	0	1	04	01	H5216_021_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	021	0	1	04	01	H5216_021_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	021	0	1	04	01	H5216_021_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	022	0	1	04	01	H5216_022_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	022	0	1	04	01	H5216_022_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	022	0	1	04	01	H5216_022_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	022	0	1	04	01	H5216_022_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	022	0	1	04	01	H5216_022_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	023	0	1	04	01	H5216_023_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	023	0	1	04	01	H5216_023_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	023	0	1	04	01	H5216_023_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	023	0	1	04	01	H5216_023_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	023	0	1	04	01	H5216_023_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	024	0	1	04	01	H5216_024_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	024	0	1	04	01	H5216_024_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	024	0	1	04	01	H5216_024_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	024	0	1	04	01	H5216_024_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	024	0	1	04	01	H5216_024_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	027	0	1	04	01	H5216_027_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	027	0	1	04	01	H5216_027_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	027	0	1	04	01	H5216_027_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	027	0	1	04	01	H5216_027_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	027	0	1	04	01	H5216_027_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	028	0	1	04	01	H5216_028_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	028	0	1	04	01	H5216_028_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	028	0	1	04	01	H5216_028_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	028	0	1	04	01	H5216_028_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	028	0	1	04	01	H5216_028_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	029	0	1	04	01	H5216_029_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	029	0	1	04	01	H5216_029_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	029	0	1	04	01	H5216_029_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	029	0	1	04	01	H5216_029_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	029	0	1	04	01	H5216_029_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	032	0	1	04	01	H5216_032_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	032	0	1	04	01	H5216_032_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	032	0	1	04	01	H5216_032_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	032	0	1	04	01	H5216_032_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	032	0	1	04	01	H5216_032_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	033	1	1	04	01	H5216_033_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	033	1	1	04	01	H5216_033_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	033	1	1	04	01	H5216_033_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	033	1	1	04	01	H5216_033_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	033	1	1	04	01	H5216_033_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	033	2	1	04	01	H5216_033_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	033	2	1	04	01	H5216_033_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	033	2	1	04	01	H5216_033_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	033	2	1	04	01	H5216_033_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	033	2	1	04	01	H5216_033_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	034	0	1	04	01	H5216_034_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	034	0	1	04	01	H5216_034_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	034	0	1	04	01	H5216_034_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	034	0	1	04	01	H5216_034_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	034	0	1	04	01	H5216_034_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	036	0	1	04	01	H5216_036_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	036	0	1	04	01	H5216_036_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	036	0	1	04	01	H5216_036_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	036	0	1	04	01	H5216_036_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	036	0	1	04	01	H5216_036_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	037	0	1	04	01	H5216_037_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	037	0	1	04	01	H5216_037_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	037	0	1	04	01	H5216_037_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	037	0	1	04	01	H5216_037_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	037	0	1	04	01	H5216_037_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	039	0	1	04	01	H5216_039_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	039	0	1	04	01	H5216_039_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	039	0	1	04	01	H5216_039_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	039	0	1	04	01	H5216_039_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	039	0	1	04	01	H5216_039_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	042	0	1	04	01	H5216_042_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	042	0	1	04	01	H5216_042_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	042	0	1	04	01	H5216_042_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	042	0	1	04	01	H5216_042_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	042	0	1	04	01	H5216_042_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	043	1	1	04	01	H5216_043_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	043	1	1	04	01	H5216_043_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	043	1	1	04	01	H5216_043_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	043	1	1	04	01	H5216_043_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	043	1	1	04	01	H5216_043_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	043	2	1	04	01	H5216_043_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	043	2	1	04	01	H5216_043_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	043	2	1	04	01	H5216_043_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	043	2	1	04	01	H5216_043_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	043	2	1	04	01	H5216_043_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	044	0	1	04	01	H5216_044_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	044	0	1	04	01	H5216_044_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	044	0	1	04	01	H5216_044_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	044	0	1	04	01	H5216_044_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	044	0	1	04	01	H5216_044_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	047	0	1	04	01	H5216_047_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	047	0	1	04	01	H5216_047_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	047	0	1	04	01	H5216_047_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	047	0	1	04	01	H5216_047_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	047	0	1	04	01	H5216_047_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	048	0	1	04	01	H5216_048_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	048	0	1	04	01	H5216_048_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	048	0	1	04	01	H5216_048_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	048	0	1	04	01	H5216_048_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	048	0	1	04	01	H5216_048_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	050	0	1	04	01	H5216_050_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	050	0	1	04	01	H5216_050_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	050	0	1	04	01	H5216_050_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	050	0	1	04	01	H5216_050_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	050	0	1	04	01	H5216_050_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	051	0	1	04	01	H5216_051_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	051	0	1	04	01	H5216_051_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	051	0	1	04	01	H5216_051_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	051	0	1	04	01	H5216_051_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	051	0	1	04	01	H5216_051_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	052	1	1	04	01	H5216_052_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	052	1	1	04	01	H5216_052_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	052	1	1	04	01	H5216_052_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	052	1	1	04	01	H5216_052_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	052	1	1	04	01	H5216_052_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	052	2	1	04	01	H5216_052_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	052	2	1	04	01	H5216_052_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	052	2	1	04	01	H5216_052_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	052	2	1	04	01	H5216_052_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	052	2	1	04	01	H5216_052_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	053	0	1	04	01	H5216_053_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	053	0	1	04	01	H5216_053_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	053	0	1	04	01	H5216_053_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	053	0	1	04	01	H5216_053_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	053	0	1	04	01	H5216_053_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	054	0	1	04	01	H5216_054_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	054	0	1	04	01	H5216_054_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	054	0	1	04	01	H5216_054_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	054	0	1	04	01	H5216_054_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	054	0	1	04	01	H5216_054_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	055	0	1	04	01	H5216_055_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	055	0	1	04	01	H5216_055_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	055	0	1	04	01	H5216_055_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	055	0	1	04	01	H5216_055_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	055	0	1	04	01	H5216_055_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	057	0	1	04	01	H5216_057_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	057	0	1	04	01	H5216_057_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	057	0	1	04	01	H5216_057_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	057	0	1	04	01	H5216_057_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	057	0	1	04	01	H5216_057_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	058	0	1	04	01	H5216_058_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	058	0	1	04	01	H5216_058_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	058	0	1	04	01	H5216_058_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	058	0	1	04	01	H5216_058_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	058	0	1	04	01	H5216_058_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	061	0	1	04	01	H5216_061_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	061	0	1	04	01	H5216_061_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	061	0	1	04	01	H5216_061_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	061	0	1	04	01	H5216_061_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	061	0	1	04	01	H5216_061_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	062	0	1	04	01	H5216_062_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	062	0	1	04	01	H5216_062_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	062	0	1	04	01	H5216_062_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	062	0	1	04	01	H5216_062_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	062	0	1	04	01	H5216_062_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	063	0	1	04	01	H5216_063_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	063	0	1	04	01	H5216_063_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	063	0	1	04	01	H5216_063_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	063	0	1	04	01	H5216_063_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	063	0	1	04	01	H5216_063_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	064	0	1	04	01	H5216_064_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	064	0	1	04	01	H5216_064_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	064	0	1	04	01	H5216_064_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	064	0	1	04	01	H5216_064_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	064	0	1	04	01	H5216_064_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	065	0	1	04	01	H5216_065_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	065	0	1	04	01	H5216_065_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	065	0	1	04	01	H5216_065_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	065	0	1	04	01	H5216_065_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	065	0	1	04	01	H5216_065_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	068	0	1	04	01	H5216_068_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	068	0	1	04	01	H5216_068_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	068	0	1	04	01	H5216_068_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	068	0	1	04	01	H5216_068_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	068	0	1	04	01	H5216_068_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	070	0	1	04	01	H5216_070_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	070	0	1	04	01	H5216_070_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	070	0	1	04	01	H5216_070_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	070	0	1	04	01	H5216_070_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	070	0	1	04	01	H5216_070_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	071	0	1	04	01	H5216_071_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	071	0	1	04	01	H5216_071_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	071	0	1	04	01	H5216_071_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	071	0	1	04	01	H5216_071_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	071	0	1	04	01	H5216_071_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	072	0	1	04	01	H5216_072_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	072	0	1	04	01	H5216_072_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	072	0	1	04	01	H5216_072_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	072	0	1	04	01	H5216_072_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	072	0	1	04	01	H5216_072_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	073	0	1	04	01	H5216_073_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	073	0	1	04	01	H5216_073_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	073	0	1	04	01	H5216_073_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	073	0	1	04	01	H5216_073_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	073	0	1	04	01	H5216_073_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	074	0	1	04	01	H5216_074_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	074	0	1	04	01	H5216_074_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	074	0	1	04	01	H5216_074_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	074	0	1	04	01	H5216_074_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	074	0	1	04	01	H5216_074_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	075	0	1	04	01	H5216_075_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	075	0	1	04	01	H5216_075_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	075	0	1	04	01	H5216_075_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	075	0	1	04	01	H5216_075_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	075	0	1	04	01	H5216_075_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	078	1	1	04	01	H5216_078_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	078	1	1	04	01	H5216_078_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	078	1	1	04	01	H5216_078_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	078	1	1	04	01	H5216_078_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	078	1	1	04	01	H5216_078_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	078	2	1	04	01	H5216_078_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	078	2	1	04	01	H5216_078_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	078	2	1	04	01	H5216_078_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	078	2	1	04	01	H5216_078_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	078	2	1	04	01	H5216_078_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	080	1	1	04	01	H5216_080_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	080	1	1	04	01	H5216_080_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	080	1	1	04	01	H5216_080_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	080	1	1	04	01	H5216_080_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	080	1	1	04	01	H5216_080_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	080	2	1	04	01	H5216_080_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	080	2	1	04	01	H5216_080_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	080	2	1	04	01	H5216_080_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	080	2	1	04	01	H5216_080_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	080	2	1	04	01	H5216_080_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	080	3	1	04	01	H5216_080_3	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	080	3	1	04	01	H5216_080_3	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	080	3	1	04	01	H5216_080_3	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	080	3	1	04	01	H5216_080_3	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	080	3	1	04	01	H5216_080_3	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	081	0	1	04	01	H5216_081_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	081	0	1	04	01	H5216_081_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5216	081	0	1	04	01	H5216_081_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	081	0	1	04	01	H5216_081_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	081	0	1	04	01	H5216_081_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	083	0	1	04	01	H5216_083_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	083	0	1	04	01	H5216_083_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	083	0	1	04	01	H5216_083_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	083	0	1	04	01	H5216_083_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	083	0	1	04	01	H5216_083_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	088	0	1	04	01	H5216_088_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	088	0	1	04	01	H5216_088_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	088	0	1	04	01	H5216_088_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	088	0	1	04	01	H5216_088_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	088	0	1	04	01	H5216_088_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	089	0	1	04	01	H5216_089_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	089	0	1	04	01	H5216_089_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	089	0	1	04	01	H5216_089_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	089	0	1	04	01	H5216_089_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	089	0	1	04	01	H5216_089_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	092	0	1	04	01	H5216_092_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	092	0	1	04	01	H5216_092_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	092	0	1	04	01	H5216_092_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	092	0	1	04	01	H5216_092_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	092	0	1	04	01	H5216_092_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	093	0	1	04	01	H5216_093_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	093	0	1	04	01	H5216_093_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	093	0	1	04	01	H5216_093_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	093	0	1	04	01	H5216_093_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	093	0	1	04	01	H5216_093_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	096	0	1	04	01	H5216_096_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	096	0	1	04	01	H5216_096_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	096	0	1	04	01	H5216_096_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	096	0	1	04	01	H5216_096_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	096	0	1	04	01	H5216_096_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	097	0	1	04	01	H5216_097_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	097	0	1	04	01	H5216_097_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	097	0	1	04	01	H5216_097_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	097	0	1	04	01	H5216_097_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	097	0	1	04	01	H5216_097_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	098	0	1	04	01	H5216_098_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	098	0	1	04	01	H5216_098_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	098	0	1	04	01	H5216_098_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	098	0	1	04	01	H5216_098_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	098	0	1	04	01	H5216_098_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	099	0	1	04	01	H5216_099_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	099	0	1	04	01	H5216_099_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	099	0	1	04	01	H5216_099_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	099	0	1	04	01	H5216_099_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	099	0	1	04	01	H5216_099_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	100	0	1	04	01	H5216_100_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	100	0	1	04	01	H5216_100_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	100	0	1	04	01	H5216_100_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	100	0	1	04	01	H5216_100_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	100	0	1	04	01	H5216_100_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	103	0	1	04	01	H5216_103_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	103	0	1	04	01	H5216_103_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	103	0	1	04	01	H5216_103_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	103	0	1	04	01	H5216_103_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	103	0	1	04	01	H5216_103_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	106	0	1	04	01	H5216_106_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	106	0	1	04	01	H5216_106_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	106	0	1	04	01	H5216_106_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	106	0	1	04	01	H5216_106_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	106	0	1	04	01	H5216_106_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	107	0	1	04	01	H5216_107_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	107	0	1	04	01	H5216_107_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	107	0	1	04	01	H5216_107_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	107	0	1	04	01	H5216_107_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	107	0	1	04	01	H5216_107_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	109	0	1	04	01	H5216_109_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	109	0	1	04	01	H5216_109_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	109	0	1	04	01	H5216_109_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	109	0	1	04	01	H5216_109_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	109	0	1	04	01	H5216_109_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	111	0	1	04	01	H5216_111_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	111	0	1	04	01	H5216_111_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	111	0	1	04	01	H5216_111_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	111	0	1	04	01	H5216_111_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	111	0	1	04	01	H5216_111_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	112	0	1	04	01	H5216_112_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	112	0	1	04	01	H5216_112_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	112	0	1	04	01	H5216_112_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	112	0	1	04	01	H5216_112_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	112	0	1	04	01	H5216_112_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	114	0	1	04	01	H5216_114_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	114	0	1	04	01	H5216_114_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	114	0	1	04	01	H5216_114_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	114	0	1	04	01	H5216_114_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	114	0	1	04	01	H5216_114_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	115	0	1	04	01	H5216_115_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	115	0	1	04	01	H5216_115_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	115	0	1	04	01	H5216_115_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	115	0	1	04	01	H5216_115_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	115	0	1	04	01	H5216_115_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	117	0	1	04	01	H5216_117_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	117	0	1	04	01	H5216_117_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	117	0	1	04	01	H5216_117_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	117	0	1	04	01	H5216_117_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	117	0	1	04	01	H5216_117_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	120	0	1	04	01	H5216_120_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	120	0	1	04	01	H5216_120_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	120	0	1	04	01	H5216_120_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	120	0	1	04	01	H5216_120_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	120	0	1	04	01	H5216_120_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	124	0	1	04	01	H5216_124_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	124	0	1	04	01	H5216_124_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	124	0	1	04	01	H5216_124_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	124	0	1	04	01	H5216_124_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	124	0	1	04	01	H5216_124_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	125	0	1	04	01	H5216_125_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	125	0	1	04	01	H5216_125_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	125	0	1	04	01	H5216_125_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	125	0	1	04	01	H5216_125_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	125	0	1	04	01	H5216_125_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	131	0	1	04	01	H5216_131_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	131	0	1	04	01	H5216_131_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	131	0	1	04	01	H5216_131_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	131	0	1	04	01	H5216_131_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	131	0	1	04	01	H5216_131_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	132	0	1	04	01	H5216_132_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	132	0	1	04	01	H5216_132_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	132	0	1	04	01	H5216_132_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	132	0	1	04	01	H5216_132_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	132	0	1	04	01	H5216_132_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	133	0	1	04	01	H5216_133_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	133	0	1	04	01	H5216_133_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	133	0	1	04	01	H5216_133_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	133	0	1	04	01	H5216_133_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	133	0	1	04	01	H5216_133_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	136	0	1	04	01	H5216_136_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	136	0	1	04	01	H5216_136_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	136	0	1	04	01	H5216_136_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	136	0	1	04	01	H5216_136_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	136	0	1	04	01	H5216_136_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	137	0	1	04	01	H5216_137_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	137	0	1	04	01	H5216_137_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	137	0	1	04	01	H5216_137_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	137	0	1	04	01	H5216_137_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	137	0	1	04	01	H5216_137_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	138	0	1	04	01	H5216_138_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	138	0	1	04	01	H5216_138_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	138	0	1	04	01	H5216_138_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	138	0	1	04	01	H5216_138_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	138	0	1	04	01	H5216_138_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	139	0	1	04	01	H5216_139_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	139	0	1	04	01	H5216_139_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	139	0	1	04	01	H5216_139_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	139	0	1	04	01	H5216_139_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	139	0	1	04	01	H5216_139_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	141	0	1	04	01	H5216_141_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	141	0	1	04	01	H5216_141_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	141	0	1	04	01	H5216_141_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	141	0	1	04	01	H5216_141_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	141	0	1	04	01	H5216_141_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	142	1	1	04	01	H5216_142_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	142	1	1	04	01	H5216_142_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	142	1	1	04	01	H5216_142_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	142	1	1	04	01	H5216_142_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	142	1	1	04	01	H5216_142_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	142	2	1	04	01	H5216_142_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	142	2	1	04	01	H5216_142_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	142	2	1	04	01	H5216_142_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	142	2	1	04	01	H5216_142_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	142	2	1	04	01	H5216_142_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	143	0	1	04	01	H5216_143_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	143	0	1	04	01	H5216_143_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	143	0	1	04	01	H5216_143_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	143	0	1	04	01	H5216_143_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	143	0	1	04	01	H5216_143_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	144	0	1	04	01	H5216_144_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	144	0	1	04	01	H5216_144_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	144	0	1	04	01	H5216_144_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	144	0	1	04	01	H5216_144_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	144	0	1	04	01	H5216_144_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	149	0	1	04	01	H5216_149_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	149	0	1	04	01	H5216_149_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	149	0	1	04	01	H5216_149_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	149	0	1	04	01	H5216_149_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	149	0	1	04	01	H5216_149_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	154	0	1	04	01	H5216_154_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	154	0	1	04	01	H5216_154_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	154	0	1	04	01	H5216_154_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	154	0	1	04	01	H5216_154_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	154	0	1	04	01	H5216_154_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	158	0	1	04	01	H5216_158_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	158	0	1	04	01	H5216_158_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	158	0	1	04	01	H5216_158_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	158	0	1	04	01	H5216_158_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	158	0	1	04	01	H5216_158_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	160	0	1	04	01	H5216_160_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	160	0	1	04	01	H5216_160_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	160	0	1	04	01	H5216_160_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	160	0	1	04	01	H5216_160_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	160	0	1	04	01	H5216_160_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	161	0	1	04	01	H5216_161_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	161	0	1	04	01	H5216_161_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	161	0	1	04	01	H5216_161_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	161	0	1	04	01	H5216_161_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	161	0	1	04	01	H5216_161_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	163	0	1	04	01	H5216_163_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	163	0	1	04	01	H5216_163_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	163	0	1	04	01	H5216_163_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	163	0	1	04	01	H5216_163_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	163	0	1	04	01	H5216_163_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	164	0	1	04	01	H5216_164_0	5	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	164	0	1	04	01	H5216_164_0	5	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	164	0	1	04	01	H5216_164_0	5	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	164	0	1	04	01	H5216_164_0	5	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	164	0	1	04	01	H5216_164_0	5	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	165	0	1	04	01	H5216_165_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	165	0	1	04	01	H5216_165_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	165	0	1	04	01	H5216_165_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	165	0	1	04	01	H5216_165_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	165	0	1	04	01	H5216_165_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	166	0	1	04	01	H5216_166_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	166	0	1	04	01	H5216_166_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	166	0	1	04	01	H5216_166_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	166	0	1	04	01	H5216_166_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	166	0	1	04	01	H5216_166_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	167	0	1	04	01	H5216_167_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	167	0	1	04	01	H5216_167_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	167	0	1	04	01	H5216_167_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	167	0	1	04	01	H5216_167_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	167	0	1	04	01	H5216_167_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	168	0	1	04	01	H5216_168_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	168	0	1	04	01	H5216_168_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	168	0	1	04	01	H5216_168_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	168	0	1	04	01	H5216_168_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	168	0	1	04	01	H5216_168_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	169	0	1	04	01	H5216_169_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	169	0	1	04	01	H5216_169_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	169	0	1	04	01	H5216_169_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	169	0	1	04	01	H5216_169_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	169	0	1	04	01	H5216_169_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	170	0	1	04	01	H5216_170_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	170	0	1	04	01	H5216_170_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	170	0	1	04	01	H5216_170_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	170	0	1	04	01	H5216_170_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	170	0	1	04	01	H5216_170_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	171	0	1	04	01	H5216_171_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	171	0	1	04	01	H5216_171_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	171	0	1	04	01	H5216_171_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	171	0	1	04	01	H5216_171_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	171	0	1	04	01	H5216_171_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	172	0	1	04	01	H5216_172_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	172	0	1	04	01	H5216_172_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	172	0	1	04	01	H5216_172_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	172	0	1	04	01	H5216_172_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	172	0	1	04	01	H5216_172_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	173	0	1	04	01	H5216_173_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	173	0	1	04	01	H5216_173_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	173	0	1	04	01	H5216_173_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	173	0	1	04	01	H5216_173_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	173	0	1	04	01	H5216_173_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	175	0	1	04	01	H5216_175_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	175	0	1	04	01	H5216_175_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	175	0	1	04	01	H5216_175_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	175	0	1	04	01	H5216_175_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	175	0	1	04	01	H5216_175_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	176	0	1	04	01	H5216_176_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	176	0	1	04	01	H5216_176_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	176	0	1	04	01	H5216_176_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	176	0	1	04	01	H5216_176_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	176	0	1	04	01	H5216_176_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	177	0	1	04	01	H5216_177_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	177	0	1	04	01	H5216_177_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	177	0	1	04	01	H5216_177_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	177	0	1	04	01	H5216_177_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	177	0	1	04	01	H5216_177_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	179	0	1	04	01	H5216_179_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	179	0	1	04	01	H5216_179_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	179	0	1	04	01	H5216_179_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	179	0	1	04	01	H5216_179_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	179	0	1	04	01	H5216_179_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	180	0	1	04	01	H5216_180_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	180	0	1	04	01	H5216_180_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	180	0	1	04	01	H5216_180_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	180	0	1	04	01	H5216_180_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	180	0	1	04	01	H5216_180_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	181	0	1	04	01	H5216_181_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	181	0	1	04	01	H5216_181_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	181	0	1	04	01	H5216_181_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	181	0	1	04	01	H5216_181_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	181	0	1	04	01	H5216_181_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	182	0	1	04	01	H5216_182_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	182	0	1	04	01	H5216_182_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	182	0	1	04	01	H5216_182_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	182	0	1	04	01	H5216_182_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	182	0	1	04	01	H5216_182_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	185	0	1	04	01	H5216_185_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	185	0	1	04	01	H5216_185_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	185	0	1	04	01	H5216_185_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	185	0	1	04	01	H5216_185_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	185	0	1	04	01	H5216_185_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	186	0	1	04	01	H5216_186_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	186	0	1	04	01	H5216_186_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	186	0	1	04	01	H5216_186_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	186	0	1	04	01	H5216_186_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	186	0	1	04	01	H5216_186_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	188	0	1	04	01	H5216_188_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	188	0	1	04	01	H5216_188_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	188	0	1	04	01	H5216_188_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	188	0	1	04	01	H5216_188_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	188	0	1	04	01	H5216_188_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	189	0	1	04	01	H5216_189_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	189	0	1	04	01	H5216_189_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	189	0	1	04	01	H5216_189_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	189	0	1	04	01	H5216_189_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	189	0	1	04	01	H5216_189_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	192	0	1	04	01	H5216_192_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	192	0	1	04	01	H5216_192_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	192	0	1	04	01	H5216_192_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	192	0	1	04	01	H5216_192_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	192	0	1	04	01	H5216_192_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	193	0	1	04	01	H5216_193_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	193	0	1	04	01	H5216_193_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	193	0	1	04	01	H5216_193_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	193	0	1	04	01	H5216_193_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	193	0	1	04	01	H5216_193_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	194	0	1	04	01	H5216_194_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	194	0	1	04	01	H5216_194_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	194	0	1	04	01	H5216_194_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	194	0	1	04	01	H5216_194_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	194	0	1	04	01	H5216_194_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	195	0	1	04	01	H5216_195_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	195	0	1	04	01	H5216_195_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	195	0	1	04	01	H5216_195_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	195	0	1	04	01	H5216_195_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	195	0	1	04	01	H5216_195_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	196	1	1	04	01	H5216_196_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	196	1	1	04	01	H5216_196_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	196	1	1	04	01	H5216_196_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	196	1	1	04	01	H5216_196_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	196	1	1	04	01	H5216_196_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	196	2	1	04	01	H5216_196_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	196	2	1	04	01	H5216_196_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	196	2	1	04	01	H5216_196_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	196	2	1	04	01	H5216_196_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	196	2	1	04	01	H5216_196_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	197	0	1	04	01	H5216_197_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	197	0	1	04	01	H5216_197_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	197	0	1	04	01	H5216_197_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	197	0	1	04	01	H5216_197_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	197	0	1	04	01	H5216_197_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	198	0	1	04	01	H5216_198_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	198	0	1	04	01	H5216_198_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	198	0	1	04	01	H5216_198_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	198	0	1	04	01	H5216_198_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	198	0	1	04	01	H5216_198_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	199	0	1	04	01	H5216_199_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	199	0	1	04	01	H5216_199_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	199	0	1	04	01	H5216_199_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	199	0	1	04	01	H5216_199_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	199	0	1	04	01	H5216_199_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	202	0	1	04	01	H5216_202_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	202	0	1	04	01	H5216_202_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	202	0	1	04	01	H5216_202_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	202	0	1	04	01	H5216_202_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	202	0	1	04	01	H5216_202_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	203	1	1	04	01	H5216_203_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	203	1	1	04	01	H5216_203_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	203	1	1	04	01	H5216_203_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	203	1	1	04	01	H5216_203_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	203	1	1	04	01	H5216_203_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	203	2	1	04	01	H5216_203_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	203	2	1	04	01	H5216_203_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	203	2	1	04	01	H5216_203_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	203	2	1	04	01	H5216_203_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	203	2	1	04	01	H5216_203_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	205	0	1	04	01	H5216_205_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	205	0	1	04	01	H5216_205_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	205	0	1	04	01	H5216_205_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	205	0	1	04	01	H5216_205_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	205	0	1	04	01	H5216_205_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	206	0	1	04	01	H5216_206_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	206	0	1	04	01	H5216_206_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	206	0	1	04	01	H5216_206_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	206	0	1	04	01	H5216_206_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	206	0	1	04	01	H5216_206_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	207	0	1	04	01	H5216_207_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	207	0	1	04	01	H5216_207_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	207	0	1	04	01	H5216_207_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	207	0	1	04	01	H5216_207_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	207	0	1	04	01	H5216_207_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	209	0	1	04	01	H5216_209_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	209	0	1	04	01	H5216_209_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	209	0	1	04	01	H5216_209_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	209	0	1	04	01	H5216_209_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	209	0	1	04	01	H5216_209_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	210	0	1	04	01	H5216_210_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	210	0	1	04	01	H5216_210_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	210	0	1	04	01	H5216_210_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	210	0	1	04	01	H5216_210_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	210	0	1	04	01	H5216_210_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	211	0	1	04	01	H5216_211_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	211	0	1	04	01	H5216_211_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	211	0	1	04	01	H5216_211_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	211	0	1	04	01	H5216_211_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	211	0	1	04	01	H5216_211_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	212	0	1	04	01	H5216_212_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	212	0	1	04	01	H5216_212_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	212	0	1	04	01	H5216_212_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	212	0	1	04	01	H5216_212_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	212	0	1	04	01	H5216_212_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	214	1	1	04	01	H5216_214_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	214	1	1	04	01	H5216_214_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	214	1	1	04	01	H5216_214_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	214	1	1	04	01	H5216_214_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	214	1	1	04	01	H5216_214_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	214	2	1	04	01	H5216_214_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	214	2	1	04	01	H5216_214_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	214	2	1	04	01	H5216_214_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	214	2	1	04	01	H5216_214_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	214	2	1	04	01	H5216_214_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	214	3	1	04	01	H5216_214_3	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	214	3	1	04	01	H5216_214_3	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	214	3	1	04	01	H5216_214_3	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	214	3	1	04	01	H5216_214_3	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	214	3	1	04	01	H5216_214_3	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	215	0	1	04	01	H5216_215_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	215	0	1	04	01	H5216_215_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	215	0	1	04	01	H5216_215_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	215	0	1	04	01	H5216_215_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	215	0	1	04	01	H5216_215_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	219	0	1	04	01	H5216_219_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	219	0	1	04	01	H5216_219_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	219	0	1	04	01	H5216_219_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	219	0	1	04	01	H5216_219_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	219	0	1	04	01	H5216_219_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	220	0	1	04	01	H5216_220_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	220	0	1	04	01	H5216_220_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	220	0	1	04	01	H5216_220_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	220	0	1	04	01	H5216_220_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	220	0	1	04	01	H5216_220_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	222	0	1	04	01	H5216_222_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	222	0	1	04	01	H5216_222_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	222	0	1	04	01	H5216_222_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	222	0	1	04	01	H5216_222_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	222	0	1	04	01	H5216_222_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	223	0	1	04	01	H5216_223_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	223	0	1	04	01	H5216_223_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	223	0	1	04	01	H5216_223_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	223	0	1	04	01	H5216_223_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	223	0	1	04	01	H5216_223_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	224	0	1	04	01	H5216_224_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	224	0	1	04	01	H5216_224_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	224	0	1	04	01	H5216_224_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	224	0	1	04	01	H5216_224_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	224	0	1	04	01	H5216_224_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	226	0	1	04	01	H5216_226_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	226	0	1	04	01	H5216_226_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	226	0	1	04	01	H5216_226_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	226	0	1	04	01	H5216_226_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	226	0	1	04	01	H5216_226_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	227	0	1	04	01	H5216_227_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	227	0	1	04	01	H5216_227_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	227	0	1	04	01	H5216_227_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	227	0	1	04	01	H5216_227_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	227	0	1	04	01	H5216_227_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	228	0	1	04	01	H5216_228_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	228	0	1	04	01	H5216_228_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	228	0	1	04	01	H5216_228_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	228	0	1	04	01	H5216_228_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	228	0	1	04	01	H5216_228_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	229	0	1	04	01	H5216_229_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	229	0	1	04	01	H5216_229_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	229	0	1	04	01	H5216_229_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	229	0	1	04	01	H5216_229_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	229	0	1	04	01	H5216_229_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	230	0	1	04	01	H5216_230_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	230	0	1	04	01	H5216_230_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5216	230	0	1	04	01	H5216_230_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	230	0	1	04	01	H5216_230_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	230	0	1	04	01	H5216_230_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	231	0	1	04	01	H5216_231_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5216	231	0	1	04	01	H5216_231_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5216	231	0	1	04	01	H5216_231_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	231	0	1	04	01	H5216_231_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	231	0	1	04	01	H5216_231_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	232	1	1	04	01	H5216_232_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	232	1	1	04	01	H5216_232_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	232	1	1	04	01	H5216_232_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	232	1	1	04	01	H5216_232_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	232	1	1	04	01	H5216_232_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	232	2	1	04	01	H5216_232_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	232	2	1	04	01	H5216_232_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	232	2	1	04	01	H5216_232_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	232	2	1	04	01	H5216_232_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	232	2	1	04	01	H5216_232_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	233	1	1	04	01	H5216_233_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	233	1	1	04	01	H5216_233_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	233	1	1	04	01	H5216_233_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	233	1	1	04	01	H5216_233_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	233	1	1	04	01	H5216_233_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	233	2	1	04	01	H5216_233_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	233	2	1	04	01	H5216_233_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	233	2	1	04	01	H5216_233_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	233	2	1	04	01	H5216_233_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	233	2	1	04	01	H5216_233_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	237	1	1	04	01	H5216_237_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	237	1	1	04	01	H5216_237_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	237	1	1	04	01	H5216_237_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	237	1	1	04	01	H5216_237_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	237	1	1	04	01	H5216_237_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	237	2	1	04	01	H5216_237_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	237	2	1	04	01	H5216_237_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	237	2	1	04	01	H5216_237_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	237	2	1	04	01	H5216_237_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	237	2	1	04	01	H5216_237_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	238	1	1	04	01	H5216_238_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	238	1	1	04	01	H5216_238_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	238	1	1	04	01	H5216_238_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	238	1	1	04	01	H5216_238_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	238	1	1	04	01	H5216_238_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	238	2	1	04	01	H5216_238_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	238	2	1	04	01	H5216_238_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	238	2	1	04	01	H5216_238_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	238	2	1	04	01	H5216_238_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	238	2	1	04	01	H5216_238_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	239	0	1	04	01	H5216_239_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	239	0	1	04	01	H5216_239_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	239	0	1	04	01	H5216_239_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	239	0	1	04	01	H5216_239_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	239	0	1	04	01	H5216_239_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	240	0	1	04	01	H5216_240_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	240	0	1	04	01	H5216_240_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	240	0	1	04	01	H5216_240_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	240	0	1	04	01	H5216_240_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	240	0	1	04	01	H5216_240_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	241	0	1	04	01	H5216_241_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	241	0	1	04	01	H5216_241_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	241	0	1	04	01	H5216_241_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	241	0	1	04	01	H5216_241_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	241	0	1	04	01	H5216_241_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	242	0	1	04	01	H5216_242_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	242	0	1	04	01	H5216_242_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	242	0	1	04	01	H5216_242_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	242	0	1	04	01	H5216_242_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	242	0	1	04	01	H5216_242_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	243	0	1	04	01	H5216_243_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	243	0	1	04	01	H5216_243_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	243	0	1	04	01	H5216_243_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	243	0	1	04	01	H5216_243_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	243	0	1	04	01	H5216_243_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	244	0	1	04	01	H5216_244_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	244	0	1	04	01	H5216_244_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	244	0	1	04	01	H5216_244_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	244	0	1	04	01	H5216_244_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	244	0	1	04	01	H5216_244_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	245	0	1	04	01	H5216_245_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	245	0	1	04	01	H5216_245_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	245	0	1	04	01	H5216_245_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	245	0	1	04	01	H5216_245_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	245	0	1	04	01	H5216_245_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	246	0	1	04	01	H5216_246_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	246	0	1	04	01	H5216_246_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	246	0	1	04	01	H5216_246_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	246	0	1	04	01	H5216_246_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	246	0	1	04	01	H5216_246_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	247	0	1	04	01	H5216_247_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	247	0	1	04	01	H5216_247_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	247	0	1	04	01	H5216_247_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	247	0	1	04	01	H5216_247_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	247	0	1	04	01	H5216_247_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	248	1	1	04	01	H5216_248_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	248	1	1	04	01	H5216_248_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	248	1	1	04	01	H5216_248_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	248	1	1	04	01	H5216_248_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	248	1	1	04	01	H5216_248_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	248	2	1	04	01	H5216_248_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	248	2	1	04	01	H5216_248_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	248	2	1	04	01	H5216_248_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	248	2	1	04	01	H5216_248_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	248	2	1	04	01	H5216_248_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	249	0	1	04	01	H5216_249_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	249	0	1	04	01	H5216_249_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	249	0	1	04	01	H5216_249_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	249	0	1	04	01	H5216_249_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	249	0	1	04	01	H5216_249_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	250	0	1	04	01	H5216_250_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	250	0	1	04	01	H5216_250_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	250	0	1	04	01	H5216_250_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	250	0	1	04	01	H5216_250_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	250	0	1	04	01	H5216_250_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	251	0	1	04	01	H5216_251_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	251	0	1	04	01	H5216_251_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	251	0	1	04	01	H5216_251_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	251	0	1	04	01	H5216_251_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	251	0	1	04	01	H5216_251_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	252	0	1	04	01	H5216_252_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	252	0	1	04	01	H5216_252_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	252	0	1	04	01	H5216_252_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	252	0	1	04	01	H5216_252_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	252	0	1	04	01	H5216_252_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	253	0	1	04	01	H5216_253_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	253	0	1	04	01	H5216_253_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	253	0	1	04	01	H5216_253_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	253	0	1	04	01	H5216_253_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	253	0	1	04	01	H5216_253_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	254	0	1	04	01	H5216_254_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	254	0	1	04	01	H5216_254_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	254	0	1	04	01	H5216_254_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	254	0	1	04	01	H5216_254_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	254	0	1	04	01	H5216_254_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5216	255	0	1	04	01	H5216_255_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5216	255	0	1	04	01	H5216_255_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5216	255	0	1	04	01	H5216_255_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5216	255	0	1	04	01	H5216_255_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5216	255	0	1	04	01	H5216_255_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5232	001	0	1	04	01	H5232_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5232	001	0	1	04	01	H5232_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5232	001	0	1	04	01	H5232_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5232	001	0	1	04	01	H5232_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5232	001	0	1	04	01	H5232_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	004	0	1	02	01	H5253_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	004	0	1	02	01	H5253_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	004	0	1	02	01	H5253_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	004	0	1	02	01	H5253_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	004	0	1	02	01	H5253_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	011	0	1	02	01	H5253_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	011	0	1	02	01	H5253_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	011	0	1	02	01	H5253_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	011	0	1	02	01	H5253_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	011	0	1	02	01	H5253_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	030	0	1	02	01	H5253_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	030	0	1	02	01	H5253_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	030	0	1	02	01	H5253_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	030	0	1	02	01	H5253_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	030	0	1	02	01	H5253_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	033	0	1	02	01	H5253_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	033	0	1	02	01	H5253_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	033	0	1	02	01	H5253_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	033	0	1	02	01	H5253_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	033	0	1	02	01	H5253_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	034	0	1	02	01	H5253_034_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	034	0	1	02	01	H5253_034_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	034	0	1	02	01	H5253_034_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	034	0	1	02	01	H5253_034_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	034	0	1	02	01	H5253_034_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	035	0	1	02	01	H5253_035_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	035	0	1	02	01	H5253_035_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	035	0	1	02	01	H5253_035_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	035	0	1	02	01	H5253_035_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	035	0	1	02	01	H5253_035_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	036	0	1	01	01	H5253_036_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	036	0	1	01	01	H5253_036_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	036	0	1	01	01	H5253_036_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	036	0	1	01	01	H5253_036_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	036	0	1	01	01	H5253_036_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	037	0	1	02	01	H5253_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	037	0	1	02	01	H5253_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	037	0	1	02	01	H5253_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	037	0	1	02	01	H5253_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	037	0	1	02	01	H5253_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	038	0	1	02	01	H5253_038_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	038	0	1	02	01	H5253_038_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	038	0	1	02	01	H5253_038_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	038	0	1	02	01	H5253_038_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	038	0	1	02	01	H5253_038_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	039	0	1	02	01	H5253_039_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	039	0	1	02	01	H5253_039_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	039	0	1	02	01	H5253_039_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	039	0	1	02	01	H5253_039_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	039	0	1	02	01	H5253_039_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	043	0	1	02	01	H5253_043_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	043	0	1	02	01	H5253_043_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	043	0	1	02	01	H5253_043_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	043	0	1	02	01	H5253_043_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	043	0	1	02	01	H5253_043_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	047	0	1	01	01	H5253_047_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	047	0	1	01	01	H5253_047_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	047	0	1	01	01	H5253_047_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	047	0	1	01	01	H5253_047_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	047	0	1	01	01	H5253_047_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	048	0	1	01	01	H5253_048_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	048	0	1	01	01	H5253_048_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	048	0	1	01	01	H5253_048_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	048	0	1	01	01	H5253_048_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	048	0	1	01	01	H5253_048_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	049	0	1	01	01	H5253_049_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	049	0	1	01	01	H5253_049_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	049	0	1	01	01	H5253_049_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	049	0	1	01	01	H5253_049_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	049	0	1	01	01	H5253_049_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	050	0	1	01	01	H5253_050_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	050	0	1	01	01	H5253_050_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	050	0	1	01	01	H5253_050_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	050	0	1	01	01	H5253_050_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	050	0	1	01	01	H5253_050_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	051	0	1	01	01	H5253_051_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	051	0	1	01	01	H5253_051_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	051	0	1	01	01	H5253_051_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	051	0	1	01	01	H5253_051_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	051	0	1	01	01	H5253_051_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	052	0	1	01	01	H5253_052_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	052	0	1	01	01	H5253_052_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	052	0	1	01	01	H5253_052_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	052	0	1	01	01	H5253_052_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	052	0	1	01	01	H5253_052_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	061	0	1	02	01	H5253_061_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	061	0	1	02	01	H5253_061_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	061	0	1	02	01	H5253_061_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	061	0	1	02	01	H5253_061_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	061	0	1	02	01	H5253_061_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	062	0	1	01	01	H5253_062_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	062	0	1	01	01	H5253_062_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	062	0	1	01	01	H5253_062_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	062	0	1	01	01	H5253_062_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	062	0	1	01	01	H5253_062_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	064	0	1	02	01	H5253_064_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	064	0	1	02	01	H5253_064_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	064	0	1	02	01	H5253_064_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	064	0	1	02	01	H5253_064_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	064	0	1	02	01	H5253_064_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	067	0	1	01	01	H5253_067_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	067	0	1	01	01	H5253_067_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	067	0	1	01	01	H5253_067_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	067	0	1	01	01	H5253_067_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	067	0	1	01	01	H5253_067_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	072	0	1	02	01	H5253_072_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	072	0	1	02	01	H5253_072_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	072	0	1	02	01	H5253_072_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	072	0	1	02	01	H5253_072_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	072	0	1	02	01	H5253_072_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	073	0	1	02	01	H5253_073_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	073	0	1	02	01	H5253_073_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	073	0	1	02	01	H5253_073_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	073	0	1	02	01	H5253_073_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	073	0	1	02	01	H5253_073_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	079	0	1	02	01	H5253_079_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	079	0	1	02	01	H5253_079_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	079	0	1	02	01	H5253_079_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	079	0	1	02	01	H5253_079_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	079	0	1	02	01	H5253_079_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	080	0	1	02	01	H5253_080_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	080	0	1	02	01	H5253_080_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	080	0	1	02	01	H5253_080_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	080	0	1	02	01	H5253_080_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	080	0	1	02	01	H5253_080_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	081	0	1	01	01	H5253_081_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	081	0	1	01	01	H5253_081_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	081	0	1	01	01	H5253_081_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	081	0	1	01	01	H5253_081_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	081	0	1	01	01	H5253_081_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	082	0	1	01	01	H5253_082_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	082	0	1	01	01	H5253_082_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	082	0	1	01	01	H5253_082_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	082	0	1	01	01	H5253_082_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	082	0	1	01	01	H5253_082_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	083	0	1	01	01	H5253_083_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	083	0	1	01	01	H5253_083_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	083	0	1	01	01	H5253_083_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	083	0	1	01	01	H5253_083_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	083	0	1	01	01	H5253_083_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	084	0	1	01	01	H5253_084_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	084	0	1	01	01	H5253_084_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	084	0	1	01	01	H5253_084_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	084	0	1	01	01	H5253_084_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	084	0	1	01	01	H5253_084_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	087	0	1	02	01	H5253_087_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	087	0	1	02	01	H5253_087_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	087	0	1	02	01	H5253_087_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	087	0	1	02	01	H5253_087_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	087	0	1	02	01	H5253_087_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	088	0	1	02	01	H5253_088_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	088	0	1	02	01	H5253_088_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	088	0	1	02	01	H5253_088_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	088	0	1	02	01	H5253_088_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	088	0	1	02	01	H5253_088_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	089	0	1	02	01	H5253_089_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	089	0	1	02	01	H5253_089_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	089	0	1	02	01	H5253_089_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	089	0	1	02	01	H5253_089_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	089	0	1	02	01	H5253_089_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	091	0	1	01	01	H5253_091_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	091	0	1	01	01	H5253_091_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	091	0	1	01	01	H5253_091_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	091	0	1	01	01	H5253_091_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	091	0	1	01	01	H5253_091_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	097	0	1	01	01	H5253_097_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	097	0	1	01	01	H5253_097_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	097	0	1	01	01	H5253_097_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	097	0	1	01	01	H5253_097_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	097	0	1	01	01	H5253_097_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	099	0	1	01	01	H5253_099_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	099	0	1	01	01	H5253_099_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	099	0	1	01	01	H5253_099_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	099	0	1	01	01	H5253_099_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	099	0	1	01	01	H5253_099_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	100	0	1	01	01	H5253_100_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	100	0	1	01	01	H5253_100_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	100	0	1	01	01	H5253_100_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	100	0	1	01	01	H5253_100_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	100	0	1	01	01	H5253_100_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	102	0	1	02	01	H5253_102_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	102	0	1	02	01	H5253_102_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	102	0	1	02	01	H5253_102_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	102	0	1	02	01	H5253_102_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	102	0	1	02	01	H5253_102_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	103	0	1	02	01	H5253_103_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	103	0	1	02	01	H5253_103_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	103	0	1	02	01	H5253_103_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	103	0	1	02	01	H5253_103_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	103	0	1	02	01	H5253_103_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	104	0	1	02	01	H5253_104_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	104	0	1	02	01	H5253_104_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	104	0	1	02	01	H5253_104_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	104	0	1	02	01	H5253_104_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	104	0	1	02	01	H5253_104_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	105	0	1	02	01	H5253_105_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	105	0	1	02	01	H5253_105_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	105	0	1	02	01	H5253_105_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	105	0	1	02	01	H5253_105_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	105	0	1	02	01	H5253_105_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	107	1	1	02	01	H5253_107_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	107	1	1	02	01	H5253_107_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	107	1	1	02	01	H5253_107_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	107	1	1	02	01	H5253_107_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	107	1	1	02	01	H5253_107_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	107	2	1	02	01	H5253_107_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	107	2	1	02	01	H5253_107_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	107	2	1	02	01	H5253_107_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	107	2	1	02	01	H5253_107_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	107	2	1	02	01	H5253_107_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	108	1	1	02	01	H5253_108_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	108	1	1	02	01	H5253_108_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	108	1	1	02	01	H5253_108_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	108	1	1	02	01	H5253_108_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	108	1	1	02	01	H5253_108_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	108	2	1	02	01	H5253_108_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	108	2	1	02	01	H5253_108_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	108	2	1	02	01	H5253_108_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	108	2	1	02	01	H5253_108_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	108	2	1	02	01	H5253_108_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	108	3	1	02	01	H5253_108_3	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	108	3	1	02	01	H5253_108_3	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	108	3	1	02	01	H5253_108_3	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	108	3	1	02	01	H5253_108_3	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	108	3	1	02	01	H5253_108_3	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	109	1	1	01	01	H5253_109_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	109	1	1	01	01	H5253_109_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	109	1	1	01	01	H5253_109_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	109	1	1	01	01	H5253_109_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	109	1	1	01	01	H5253_109_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	109	2	1	01	01	H5253_109_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	109	2	1	01	01	H5253_109_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	109	2	1	01	01	H5253_109_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	109	2	1	01	01	H5253_109_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	109	2	1	01	01	H5253_109_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	110	0	1	02	01	H5253_110_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	110	0	1	02	01	H5253_110_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	110	0	1	02	01	H5253_110_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	110	0	1	02	01	H5253_110_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	110	0	1	02	01	H5253_110_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	111	1	1	02	01	H5253_111_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	111	1	1	02	01	H5253_111_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	111	1	1	02	01	H5253_111_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	111	1	1	02	01	H5253_111_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	111	1	1	02	01	H5253_111_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	111	2	1	02	01	H5253_111_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	111	2	1	02	01	H5253_111_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	111	2	1	02	01	H5253_111_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	111	2	1	02	01	H5253_111_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	111	2	1	02	01	H5253_111_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	112	1	1	02	01	H5253_112_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	112	1	1	02	01	H5253_112_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	112	1	1	02	01	H5253_112_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	112	1	1	02	01	H5253_112_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	112	1	1	02	01	H5253_112_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5253	112	2	1	02	01	H5253_112_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5253	112	2	1	02	01	H5253_112_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5253	112	2	1	02	01	H5253_112_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5253	112	2	1	02	01	H5253_112_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5253	112	2	1	02	01	H5253_112_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	001	0	1	01	01	H5262_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	001	0	1	01	01	H5262_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	001	0	1	01	01	H5262_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	001	0	1	01	01	H5262_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	001	0	1	01	01	H5262_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	003	0	1	01	01	H5262_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	003	0	1	01	01	H5262_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	003	0	1	01	01	H5262_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	003	0	1	01	01	H5262_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	003	0	1	01	01	H5262_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	007	0	1	01	01	H5262_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	007	0	1	01	01	H5262_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	007	0	1	01	01	H5262_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	007	0	1	01	01	H5262_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	007	0	1	01	01	H5262_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	008	0	1	01	01	H5262_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	008	0	1	01	01	H5262_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	008	0	1	01	01	H5262_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	008	0	1	01	01	H5262_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	008	0	1	01	01	H5262_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	011	0	1	01	01	H5262_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	011	0	1	01	01	H5262_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	011	0	1	01	01	H5262_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	011	0	1	01	01	H5262_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	011	0	1	01	01	H5262_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	012	0	1	01	01	H5262_012_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	012	0	1	01	01	H5262_012_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	012	0	1	01	01	H5262_012_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	012	0	1	01	01	H5262_012_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	012	0	1	01	01	H5262_012_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	018	0	1	01	01	H5262_018_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	018	0	1	01	01	H5262_018_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	018	0	1	01	01	H5262_018_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	018	0	1	01	01	H5262_018_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	018	0	1	01	01	H5262_018_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	019	0	1	01	01	H5262_019_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	019	0	1	01	01	H5262_019_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	019	0	1	01	01	H5262_019_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	019	0	1	01	01	H5262_019_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	019	0	1	01	01	H5262_019_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	021	0	1	01	01	H5262_021_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	021	0	1	01	01	H5262_021_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	021	0	1	01	01	H5262_021_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	021	0	1	01	01	H5262_021_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	021	0	1	01	01	H5262_021_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	023	0	1	01	01	H5262_023_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	023	0	1	01	01	H5262_023_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	023	0	1	01	01	H5262_023_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	023	0	1	01	01	H5262_023_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	023	0	1	01	01	H5262_023_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	024	0	1	01	01	H5262_024_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	024	0	1	01	01	H5262_024_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	024	0	1	01	01	H5262_024_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	024	0	1	01	01	H5262_024_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	024	0	1	01	01	H5262_024_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5262	026	0	1	01	01	H5262_026_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5262	026	0	1	01	01	H5262_026_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5262	026	0	1	01	01	H5262_026_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5262	026	0	1	01	01	H5262_026_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5262	026	0	1	01	01	H5262_026_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5273	001	0	1	01	01	H5273_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H5273	001	0	1	01	01	H5273_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H5273	001	0	1	01	01	H5273_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5273	001	0	1	01	01	H5273_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5273	001	0	1	01	01	H5273_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5273	001	0	1	01	01	H5273_001_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5273	002	0	1	01	01	H5273_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H5273	002	0	1	01	01	H5273_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H5273	002	0	1	01	01	H5273_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5273	002	0	1	01	01	H5273_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5273	002	0	1	01	01	H5273_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5273	002	0	1	01	01	H5273_002_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5273	003	0	1	01	01	H5273_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	1	2	01	1						
H5273	003	0	1	01	01	H5273_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	2	2	01	1						
H5273	003	0	1	01	01	H5273_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	3	2	11	1						
H5273	003	0	1	01	01	H5273_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	4	2	11	1						
H5273	003	0	1	01	01	H5273_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	5	2	11	1						
H5273	003	0	1	01	01	H5273_003_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines	6	2	11	1						
H5280	001	0	1	48	05	H5280_001_0	6	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H5280	001	0	1	48	05	H5280_001_0	6	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H5280	001	0	1	48	05	H5280_001_0	6	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H5294	010	0	1	01	01	H5294_010_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5294	010	0	1	01	01	H5294_010_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5294	010	0	1	01	01	H5294_010_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5294	010	0	1	01	01	H5294_010_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5294	010	0	1	01	01	H5294_010_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5294	011	0	1	01	01	H5294_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5294	011	0	1	01	01	H5294_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5294	011	0	1	01	01	H5294_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5294	011	0	1	01	01	H5294_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5294	011	0	1	01	01	H5294_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5294	011	0	1	01	01	H5294_011_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5294	012	0	1	01	01	H5294_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5294	012	0	1	01	01	H5294_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5294	012	0	1	01	01	H5294_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5294	012	0	1	01	01	H5294_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5294	012	0	1	01	01	H5294_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5294	012	0	1	01	01	H5294_012_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5294	013	0	1	01	01	H5294_013_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5294	013	0	1	01	01	H5294_013_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5294	013	0	1	01	01	H5294_013_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5294	013	0	1	01	01	H5294_013_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5294	013	0	1	01	01	H5294_013_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5294	015	0	1	01	01	H5294_015_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5294	015	0	1	01	01	H5294_015_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5294	015	0	1	01	01	H5294_015_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5294	015	0	1	01	01	H5294_015_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5294	015	0	1	01	01	H5294_015_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5294	016	0	1	01	01	H5294_016_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5294	016	0	1	01	01	H5294_016_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5294	016	0	1	01	01	H5294_016_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5294	016	0	1	01	01	H5294_016_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5294	016	0	1	01	01	H5294_016_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5294	017	0	1	01	01	H5294_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5294	017	0	1	01	01	H5294_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5294	017	0	1	01	01	H5294_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5294	017	0	1	01	01	H5294_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5294	017	0	1	01	01	H5294_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5294	017	0	1	01	01	H5294_017_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5294	018	0	1	01	01	H5294_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5294	018	0	1	01	01	H5294_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5294	018	0	1	01	01	H5294_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5294	018	0	1	01	01	H5294_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5294	018	0	1	01	01	H5294_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5294	018	0	1	01	01	H5294_018_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5296	001	0	1	01	01	H5296_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5296	001	0	1	01	01	H5296_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H5296	001	0	1	01	01	H5296_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5296	001	0	1	01	01	H5296_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H5296	001	0	1	01	01	H5296_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5296	001	0	1	01	01	H5296_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5296	002	0	1	01	01	H5296_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5296	002	0	1	01	01	H5296_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5296	002	0	1	01	01	H5296_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5296	002	0	1	01	01	H5296_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5296	002	0	1	01	01	H5296_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5296	002	0	1	01	01	H5296_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5296	003	0	1	02	01	H5296_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5296	003	0	1	02	01	H5296_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H5296	003	0	1	02	01	H5296_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5296	003	0	1	02	01	H5296_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H5296	003	0	1	02	01	H5296_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5296	003	0	1	02	01	H5296_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5302	011	0	1	01	01	H5302_011_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5302	011	0	1	01	01	H5302_011_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5302	011	0	1	01	01	H5302_011_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5302	011	0	1	01	01	H5302_011_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5302	011	0	1	01	01	H5302_011_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5302	012	0	1	01	01	H5302_012_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5302	012	0	1	01	01	H5302_012_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5302	012	0	1	01	01	H5302_012_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5302	012	0	1	01	01	H5302_012_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5302	012	0	1	01	01	H5302_012_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5302	013	0	1	01	01	H5302_013_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5302	013	0	1	01	01	H5302_013_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5302	013	0	1	01	01	H5302_013_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5302	013	0	1	01	01	H5302_013_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5302	013	0	1	01	01	H5302_013_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5302	014	0	1	01	01	H5302_014_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5302	014	0	1	01	01	H5302_014_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5302	014	0	1	01	01	H5302_014_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5302	014	0	1	01	01	H5302_014_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5302	014	0	1	01	01	H5302_014_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5325	001	0	1	01	01	H5325_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5325	001	0	1	01	01	H5325_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5325	001	0	1	01	01	H5325_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5325	001	0	1	01	01	H5325_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5325	001	0	1	01	01	H5325_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5325	002	0	1	01	01	H5325_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5325	002	0	1	01	01	H5325_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5325	002	0	1	01	01	H5325_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5325	002	0	1	01	01	H5325_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5325	002	0	1	01	01	H5325_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5325	003	0	1	01	01	H5325_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5325	003	0	1	01	01	H5325_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5325	003	0	1	01	01	H5325_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5325	003	0	1	01	01	H5325_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5325	003	0	1	01	01	H5325_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5325	004	0	1	01	01	H5325_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5325	004	0	1	01	01	H5325_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5325	004	0	1	01	01	H5325_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5325	004	0	1	01	01	H5325_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5325	004	0	1	01	01	H5325_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5325	005	0	1	01	01	H5325_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5325	005	0	1	01	01	H5325_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5325	005	0	1	01	01	H5325_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5325	005	0	1	01	01	H5325_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5325	005	0	1	01	01	H5325_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5325	006	0	1	01	01	H5325_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5325	006	0	1	01	01	H5325_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5325	006	0	1	01	01	H5325_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5325	006	0	1	01	01	H5325_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5325	006	0	1	01	01	H5325_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5337	001	0	1	01	01	H5337_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5337	001	0	1	01	01	H5337_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5337	001	0	1	01	01	H5337_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5337	001	0	1	01	01	H5337_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5337	001	0	1	01	01	H5337_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5355	001	0	1	48	05	H5355_001_0	2	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H5355	001	0	1	48	05	H5355_001_0	2	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H5355	001	0	1	48	05	H5355_001_0	2	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H5373	001	0	1	01	01	H5373_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5373	001	0	1	01	01	H5373_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5373	001	0	1	01	01	H5373_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5373	001	0	1	01	01	H5373_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5373	001	0	1	01	01	H5373_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5377	001	0	1	01	01	H5377_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5377	001	0	1	01	01	H5377_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5377	001	0	1	01	01	H5377_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5377	001	0	1	01	01	H5377_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5377	001	0	1	01	01	H5377_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5386	003	0	1	01	01	H5386_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5386	003	0	1	01	01	H5386_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5386	003	0	1	01	01	H5386_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5386	003	0	1	01	01	H5386_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5386	003	0	1	01	01	H5386_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5386	003	0	1	01	01	H5386_003_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5386	004	0	1	01	01	H5386_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5386	004	0	1	01	01	H5386_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5386	004	0	1	01	01	H5386_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5386	004	0	1	01	01	H5386_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5386	004	0	1	01	01	H5386_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5386	004	0	1	01	01	H5386_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5398	001	0	1	01	01	H5398_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5398	001	0	1	01	01	H5398_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5398	001	0	1	01	01	H5398_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5398	001	0	1	01	01	H5398_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5398	001	0	1	01	01	H5398_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5398	001	0	1	01	01	H5398_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5398	002	0	1	01	01	H5398_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5398	002	0	1	01	01	H5398_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5398	002	0	1	01	01	H5398_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5398	002	0	1	01	01	H5398_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5398	002	0	1	01	01	H5398_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5398	002	0	1	01	01	H5398_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5410	001	0	1	01	01	H5410_001_0	8	Generic	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5410	001	0	1	01	01	H5410_001_0	8	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	10	1						
H5410	001	0	1	01	01	H5410_001_0	8	Non-Preferred Drug	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	001	0	1	01	01	H5410_001_0	8	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	018	0	1	01	01	H5410_018_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	018	0	1	01	01	H5410_018_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	018	0	1	01	01	H5410_018_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	018	0	1	01	01	H5410_018_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	018	0	1	01	01	H5410_018_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	024	0	1	01	01	H5410_024_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	024	0	1	01	01	H5410_024_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	024	0	1	01	01	H5410_024_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	024	0	1	01	01	H5410_024_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	024	0	1	01	01	H5410_024_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	025	0	1	01	01	H5410_025_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	025	0	1	01	01	H5410_025_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	025	0	1	01	01	H5410_025_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	025	0	1	01	01	H5410_025_0	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	025	0	1	01	01	H5410_025_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	026	0	1	01	01	H5410_026_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	026	0	1	01	01	H5410_026_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	026	0	1	01	01	H5410_026_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	026	0	1	01	01	H5410_026_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	026	0	1	01	01	H5410_026_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	027	0	1	01	01	H5410_027_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	027	0	1	01	01	H5410_027_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	027	0	1	01	01	H5410_027_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	027	0	1	01	01	H5410_027_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	027	0	1	01	01	H5410_027_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	028	0	1	01	01	H5410_028_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	028	0	1	01	01	H5410_028_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	028	0	1	01	01	H5410_028_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	028	0	1	01	01	H5410_028_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	028	0	1	01	01	H5410_028_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	029	0	1	01	01	H5410_029_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5410	029	0	1	01	01	H5410_029_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	029	0	1	01	01	H5410_029_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	029	0	1	01	01	H5410_029_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	029	0	1	01	01	H5410_029_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	030	0	1	01	01	H5410_030_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5410	030	0	1	01	01	H5410_030_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	030	0	1	01	01	H5410_030_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	030	0	1	01	01	H5410_030_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	030	0	1	01	01	H5410_030_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	031	0	1	01	01	H5410_031_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	031	0	1	01	01	H5410_031_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	031	0	1	01	01	H5410_031_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	031	0	1	01	01	H5410_031_0	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	031	0	1	01	01	H5410_031_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	032	0	1	01	01	H5410_032_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	032	0	1	01	01	H5410_032_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	032	0	1	01	01	H5410_032_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	032	0	1	01	01	H5410_032_0	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	032	0	1	01	01	H5410_032_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	033	0	1	01	01	H5410_033_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	033	0	1	01	01	H5410_033_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	033	0	1	01	01	H5410_033_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	033	0	1	01	01	H5410_033_0	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	033	0	1	01	01	H5410_033_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	034	0	1	01	01	H5410_034_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	034	0	1	01	01	H5410_034_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	034	0	1	01	01	H5410_034_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	034	0	1	01	01	H5410_034_0	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	034	0	1	01	01	H5410_034_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	035	0	1	01	01	H5410_035_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	035	0	1	01	01	H5410_035_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	035	0	1	01	01	H5410_035_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	035	0	1	01	01	H5410_035_0	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	035	0	1	01	01	H5410_035_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5410	036	0	1	01	01	H5410_036_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5410	036	0	1	01	01	H5410_036_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5410	036	0	1	01	01	H5410_036_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5410	036	0	1	01	01	H5410_036_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5410	036	0	1	01	01	H5410_036_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5420	001	0	1	01	01	H5420_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5420	001	0	1	01	01	H5420_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5420	001	0	1	01	01	H5420_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5420	001	0	1	01	01	H5420_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5420	001	0	1	01	01	H5420_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5420	003	0	1	01	01	H5420_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5420	003	0	1	01	01	H5420_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5420	003	0	1	01	01	H5420_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5420	003	0	1	01	01	H5420_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5420	003	0	1	01	01	H5420_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5420	006	0	1	01	01	H5420_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5420	006	0	1	01	01	H5420_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5420	006	0	1	01	01	H5420_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5420	006	0	1	01	01	H5420_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5420	006	0	1	01	01	H5420_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5422	007	0	1	01	01	H5422_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5422	007	0	1	01	01	H5422_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5422	007	0	1	01	01	H5422_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5422	007	0	1	01	01	H5422_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5422	007	0	1	01	01	H5422_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5422	007	0	1	01	01	H5422_007_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5422	008	0	1	01	01	H5422_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5422	008	0	1	01	01	H5422_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5422	008	0	1	01	01	H5422_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5422	008	0	1	01	01	H5422_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5422	008	0	1	01	01	H5422_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5422	008	0	1	01	01	H5422_008_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5422	011	0	1	01	01	H5422_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5422	011	0	1	01	01	H5422_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5422	011	0	1	01	01	H5422_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5422	011	0	1	01	01	H5422_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5422	011	0	1	01	01	H5422_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5422	011	0	1	01	01	H5422_011_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5422	013	0	1	01	01	H5422_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H5422	013	0	1	01	01	H5422_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5422	013	0	1	01	01	H5422_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5422	013	0	1	01	01	H5422_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5422	013	0	1	01	01	H5422_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5422	013	0	1	01	01	H5422_013_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5425	001	0	1	01	01	H5425_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	001	0	1	01	01	H5425_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	001	0	1	01	01	H5425_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	001	0	1	01	01	H5425_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	001	0	1	01	01	H5425_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	004	0	1	01	01	H5425_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	004	0	1	01	01	H5425_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	004	0	1	01	01	H5425_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	004	0	1	01	01	H5425_004_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	004	0	1	01	01	H5425_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	005	0	1	01	01	H5425_005_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	005	0	1	01	01	H5425_005_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	005	0	1	01	01	H5425_005_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	005	0	1	01	01	H5425_005_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	005	0	1	01	01	H5425_005_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	006	0	1	01	01	H5425_006_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	006	0	1	01	01	H5425_006_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	006	0	1	01	01	H5425_006_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	006	0	1	01	01	H5425_006_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	006	0	1	01	01	H5425_006_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	007	0	1	01	01	H5425_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	007	0	1	01	01	H5425_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	007	0	1	01	01	H5425_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	007	0	1	01	01	H5425_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	007	0	1	01	01	H5425_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	008	0	1	01	01	H5425_008_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	008	0	1	01	01	H5425_008_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	008	0	1	01	01	H5425_008_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	008	0	1	01	01	H5425_008_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	008	0	1	01	01	H5425_008_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	009	0	1	01	01	H5425_009_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	009	0	1	01	01	H5425_009_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	009	0	1	01	01	H5425_009_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	009	0	1	01	01	H5425_009_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	009	0	1	01	01	H5425_009_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	010	0	1	01	01	H5425_010_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	010	0	1	01	01	H5425_010_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	010	0	1	01	01	H5425_010_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	010	0	1	01	01	H5425_010_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	010	0	1	01	01	H5425_010_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	019	0	1	01	01	H5425_019_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	019	0	1	01	01	H5425_019_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	019	0	1	01	01	H5425_019_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	019	0	1	01	01	H5425_019_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	019	0	1	01	01	H5425_019_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	020	0	1	01	01	H5425_020_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	020	0	1	01	01	H5425_020_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	020	0	1	01	01	H5425_020_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	020	0	1	01	01	H5425_020_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	020	0	1	01	01	H5425_020_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	028	0	1	01	01	H5425_028_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	028	0	1	01	01	H5425_028_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	028	0	1	01	01	H5425_028_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	028	0	1	01	01	H5425_028_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	028	0	1	01	01	H5425_028_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	030	0	1	01	01	H5425_030_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	030	0	1	01	01	H5425_030_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	030	0	1	01	01	H5425_030_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	030	0	1	01	01	H5425_030_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	030	0	1	01	01	H5425_030_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	033	0	1	01	01	H5425_033_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	033	0	1	01	01	H5425_033_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	033	0	1	01	01	H5425_033_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	033	0	1	01	01	H5425_033_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	033	0	1	01	01	H5425_033_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	034	0	1	01	01	H5425_034_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	034	0	1	01	01	H5425_034_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	034	0	1	01	01	H5425_034_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	034	0	1	01	01	H5425_034_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	034	0	1	01	01	H5425_034_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	040	0	1	01	01	H5425_040_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	040	0	1	01	01	H5425_040_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	040	0	1	01	01	H5425_040_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	040	0	1	01	01	H5425_040_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	040	0	1	01	01	H5425_040_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	045	0	1	01	01	H5425_045_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	045	0	1	01	01	H5425_045_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	045	0	1	01	01	H5425_045_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	045	0	1	01	01	H5425_045_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	045	0	1	01	01	H5425_045_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	052	0	1	01	01	H5425_052_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	052	0	1	01	01	H5425_052_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	052	0	1	01	01	H5425_052_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	052	0	1	01	01	H5425_052_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	052	0	1	01	01	H5425_052_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	053	0	1	01	01	H5425_053_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	053	0	1	01	01	H5425_053_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	053	0	1	01	01	H5425_053_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	053	0	1	01	01	H5425_053_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	053	0	1	01	01	H5425_053_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	054	0	1	01	01	H5425_054_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	054	0	1	01	01	H5425_054_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	054	0	1	01	01	H5425_054_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	054	0	1	01	01	H5425_054_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	054	0	1	01	01	H5425_054_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	055	0	1	01	01	H5425_055_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	055	0	1	01	01	H5425_055_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	055	0	1	01	01	H5425_055_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	055	0	1	01	01	H5425_055_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	055	0	1	01	01	H5425_055_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	064	0	1	01	01	H5425_064_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	064	0	1	01	01	H5425_064_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	064	0	1	01	01	H5425_064_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	064	0	1	01	01	H5425_064_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	064	0	1	01	01	H5425_064_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	065	0	1	01	01	H5425_065_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	065	0	1	01	01	H5425_065_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	065	0	1	01	01	H5425_065_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	065	0	1	01	01	H5425_065_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	065	0	1	01	01	H5425_065_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	066	0	1	01	01	H5425_066_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	066	0	1	01	01	H5425_066_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	066	0	1	01	01	H5425_066_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	066	0	1	01	01	H5425_066_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	066	0	1	01	01	H5425_066_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	067	0	1	01	01	H5425_067_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	067	0	1	01	01	H5425_067_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	067	0	1	01	01	H5425_067_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	067	0	1	01	01	H5425_067_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	067	0	1	01	01	H5425_067_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	068	0	1	01	01	H5425_068_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5425	068	0	1	01	01	H5425_068_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	068	0	1	01	01	H5425_068_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	068	0	1	01	01	H5425_068_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	068	0	1	01	01	H5425_068_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	069	0	1	01	01	H5425_069_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	069	0	1	01	01	H5425_069_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	069	0	1	01	01	H5425_069_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	069	0	1	01	01	H5425_069_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	069	0	1	01	01	H5425_069_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	070	0	1	01	01	H5425_070_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	070	0	1	01	01	H5425_070_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	070	0	1	01	01	H5425_070_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	070	0	1	01	01	H5425_070_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	070	0	1	01	01	H5425_070_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	071	0	1	01	01	H5425_071_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	071	0	1	01	01	H5425_071_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	071	0	1	01	01	H5425_071_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	071	0	1	01	01	H5425_071_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	071	0	1	01	01	H5425_071_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	072	0	1	01	01	H5425_072_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	072	0	1	01	01	H5425_072_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	072	0	1	01	01	H5425_072_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	072	0	1	01	01	H5425_072_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	072	0	1	01	01	H5425_072_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	073	0	1	01	01	H5425_073_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	073	0	1	01	01	H5425_073_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	073	0	1	01	01	H5425_073_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	073	0	1	01	01	H5425_073_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	073	0	1	01	01	H5425_073_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5425	074	0	1	01	01	H5425_074_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5425	074	0	1	01	01	H5425_074_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5425	074	0	1	01	01	H5425_074_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5425	074	0	1	01	01	H5425_074_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5425	074	0	1	01	01	H5425_074_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5427	059	0	1	01	01	H5427_059_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	059	0	1	01	01	H5427_059_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	059	0	1	01	01	H5427_059_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	059	0	1	01	01	H5427_059_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	060	0	1	01	01	H5427_060_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	060	0	1	01	01	H5427_060_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	060	0	1	01	01	H5427_060_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	060	0	1	01	01	H5427_060_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	070	0	1	01	01	H5427_070_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	11	3						
H5427	070	0	1	01	01	H5427_070_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	11	3						
H5427	070	0	1	01	01	H5427_070_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	3						
H5427	070	0	1	01	01	H5427_070_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H5427	070	0	1	01	01	H5427_070_0	6	Select Diabetic Drugs	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	10	1						
H5427	072	0	1	01	01	H5427_072_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	11	3						
H5427	072	0	1	01	01	H5427_072_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	11	3						
H5427	072	0	1	01	01	H5427_072_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	3						
H5427	072	0	1	01	01	H5427_072_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H5427	072	0	1	01	01	H5427_072_0	6	Select Diabetic Drugs	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	10	1						
H5427	077	0	1	01	01	H5427_077_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	077	0	1	01	01	H5427_077_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	077	0	1	01	01	H5427_077_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	077	0	1	01	01	H5427_077_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	078	0	1	01	01	H5427_078_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	078	0	1	01	01	H5427_078_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	078	0	1	01	01	H5427_078_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	078	0	1	01	01	H5427_078_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	082	0	1	01	01	H5427_082_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	11	3						
H5427	082	0	1	01	01	H5427_082_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	11	3						
H5427	082	0	1	01	01	H5427_082_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	3						
H5427	082	0	1	01	01	H5427_082_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H5427	082	0	1	01	01	H5427_082_0	6	Select Diabetic Drugs	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	10	1						
H5427	083	0	1	01	01	H5427_083_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	083	0	1	01	01	H5427_083_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	083	0	1	01	01	H5427_083_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	083	0	1	01	01	H5427_083_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	087	0	1	01	01	H5427_087_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	087	0	1	01	01	H5427_087_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	087	0	1	01	01	H5427_087_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	087	0	1	01	01	H5427_087_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	088	0	1	01	01	H5427_088_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	088	0	1	01	01	H5427_088_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	088	0	1	01	01	H5427_088_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	088	0	1	01	01	H5427_088_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	089	0	1	01	01	H5427_089_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	089	0	1	01	01	H5427_089_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	089	0	1	01	01	H5427_089_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	089	0	1	01	01	H5427_089_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	091	0	1	01	01	H5427_091_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	091	0	1	01	01	H5427_091_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	091	0	1	01	01	H5427_091_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	091	0	1	01	01	H5427_091_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	092	0	1	01	01	H5427_092_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	092	0	1	01	01	H5427_092_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	092	0	1	01	01	H5427_092_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	092	0	1	01	01	H5427_092_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	093	0	1	01	01	H5427_093_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	093	0	1	01	01	H5427_093_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	093	0	1	01	01	H5427_093_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	093	0	1	01	01	H5427_093_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	094	0	1	01	01	H5427_094_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	094	0	1	01	01	H5427_094_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	094	0	1	01	01	H5427_094_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	094	0	1	01	01	H5427_094_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	096	0	1	01	01	H5427_096_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	096	0	1	01	01	H5427_096_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	096	0	1	01	01	H5427_096_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	096	0	1	01	01	H5427_096_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	098	0	1	01	01	H5427_098_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	098	0	1	01	01	H5427_098_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	098	0	1	01	01	H5427_098_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	098	0	1	01	01	H5427_098_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	099	0	1	01	01	H5427_099_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	11	3						
H5427	099	0	1	01	01	H5427_099_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	11	3						
H5427	099	0	1	01	01	H5427_099_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	3						
H5427	099	0	1	01	01	H5427_099_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H5427	099	0	1	01	01	H5427_099_0	6	Select Diabetic Drugs	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	10	1						
H5427	102	0	1	01	01	H5427_102_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	102	0	1	01	01	H5427_102_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	102	0	1	01	01	H5427_102_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	102	0	1	01	01	H5427_102_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5427	103	0	1	01	01	H5427_103_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5427	103	0	1	01	01	H5427_103_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5427	103	0	1	01	01	H5427_103_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5427	103	0	1	01	01	H5427_103_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5430	001	0	1	01	01	H5430_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5430	001	0	1	01	01	H5430_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5430	001	0	1	01	01	H5430_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5430	001	0	1	01	01	H5430_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5430	001	0	1	01	01	H5430_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5431	001	0	1	01	01	H5431_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H5431	001	0	1	01	01	H5431_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H5431	001	0	1	01	01	H5431_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H5431	001	0	1	01	01	H5431_001_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H5431	001	0	1	01	01	H5431_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H5431	001	0	1	01	01	H5431_001_0	7	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2	2	0.00				
H5431	006	0	1	01	01	H5431_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H5431	006	0	1	01	01	H5431_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H5431	006	0	1	01	01	H5431_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H5431	006	0	1	01	01	H5431_006_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H5431	006	0	1	01	01	H5431_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H5431	006	0	1	01	01	H5431_006_0	7	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2	2	0.00				
H5431	012	0	1	01	01	H5431_012_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H5431	012	0	1	01	01	H5431_012_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H5431	012	0	1	01	01	H5431_012_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H5431	012	0	1	01	01	H5431_012_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H5431	012	0	1	01	01	H5431_012_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H5431	012	0	1	01	01	H5431_012_0	7	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2	2	0.00				
H5431	013	0	1	01	01	H5431_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H5431	013	0	1	01	01	H5431_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H5431	013	0	1	01	01	H5431_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H5431	013	0	1	01	01	H5431_013_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H5431	013	0	1	01	01	H5431_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H5431	013	0	1	01	01	H5431_013_0	6	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2	2	0.00				
H5431	014	0	1	01	01	H5431_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H5431	014	0	1	01	01	H5431_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H5431	014	0	1	01	01	H5431_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H5431	014	0	1	01	01	H5431_014_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H5431	014	0	1	01	01	H5431_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H5431	014	0	1	01	01	H5431_014_0	6	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2	2	0.00				
H5431	015	0	1	01	01	H5431_015_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H5431	015	0	1	01	01	H5431_015_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H5431	015	0	1	01	01	H5431_015_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H5431	015	0	1	01	01	H5431_015_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H5431	015	0	1	01	01	H5431_015_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H5431	015	0	1	01	01	H5431_015_0	6	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2	2	0.00				
H5431	016	0	1	01	01	H5431_016_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H5431	016	0	1	01	01	H5431_016_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H5431	016	0	1	01	01	H5431_016_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H5431	016	0	1	01	01	H5431_016_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	10	1						
H5431	016	0	1	01	01	H5431_016_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H5431	016	0	1	01	01	H5431_016_0	6	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2	2	0.00				
H5433	001	0	1	01	01	H5433_001_0	5	Generic	4	Generic, Brand	1	2	11	1						
H5433	001	0	1	01	01	H5433_001_0	5	Brand	4	Generic, Brand	2	2	11	1						
H5434	002	0	1	04	01	H5434_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	002	0	1	04	01	H5434_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	002	0	1	04	01	H5434_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	002	0	1	04	01	H5434_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	002	0	1	04	01	H5434_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	002	0	1	04	01	H5434_002_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	023	0	1	04	01	H5434_023_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	023	0	1	04	01	H5434_023_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	023	0	1	04	01	H5434_023_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	023	0	1	04	01	H5434_023_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	023	0	1	04	01	H5434_023_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	023	0	1	04	01	H5434_023_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	024	0	1	04	01	H5434_024_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	024	0	1	04	01	H5434_024_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	024	0	1	04	01	H5434_024_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	024	0	1	04	01	H5434_024_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	024	0	1	04	01	H5434_024_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	024	0	1	04	01	H5434_024_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	025	0	1	04	01	H5434_025_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	025	0	1	04	01	H5434_025_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	025	0	1	04	01	H5434_025_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	025	0	1	04	01	H5434_025_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	025	0	1	04	01	H5434_025_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	025	0	1	04	01	H5434_025_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	026	0	1	04	01	H5434_026_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	026	0	1	04	01	H5434_026_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	026	0	1	04	01	H5434_026_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	026	0	1	04	01	H5434_026_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	026	0	1	04	01	H5434_026_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	026	0	1	04	01	H5434_026_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	030	0	1	04	01	H5434_030_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	030	0	1	04	01	H5434_030_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	030	0	1	04	01	H5434_030_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	030	0	1	04	01	H5434_030_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	030	0	1	04	01	H5434_030_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	030	0	1	04	01	H5434_030_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	031	0	1	04	01	H5434_031_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	031	0	1	04	01	H5434_031_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	031	0	1	04	01	H5434_031_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	031	0	1	04	01	H5434_031_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	031	0	1	04	01	H5434_031_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	031	0	1	04	01	H5434_031_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	032	0	1	04	01	H5434_032_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	032	0	1	04	01	H5434_032_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	032	0	1	04	01	H5434_032_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	032	0	1	04	01	H5434_032_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	032	0	1	04	01	H5434_032_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	032	0	1	04	01	H5434_032_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	033	0	1	04	01	H5434_033_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	033	0	1	04	01	H5434_033_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	033	0	1	04	01	H5434_033_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	033	0	1	04	01	H5434_033_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	033	0	1	04	01	H5434_033_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	033	0	1	04	01	H5434_033_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	034	0	1	04	01	H5434_034_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	034	0	1	04	01	H5434_034_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	034	0	1	04	01	H5434_034_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	034	0	1	04	01	H5434_034_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	034	0	1	04	01	H5434_034_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	034	0	1	04	01	H5434_034_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	035	0	1	04	01	H5434_035_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	035	0	1	04	01	H5434_035_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	035	0	1	04	01	H5434_035_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	035	0	1	04	01	H5434_035_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	035	0	1	04	01	H5434_035_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	035	0	1	04	01	H5434_035_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5434	036	0	1	04	01	H5434_036_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5434	036	0	1	04	01	H5434_036_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5434	036	0	1	04	01	H5434_036_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5434	036	0	1	04	01	H5434_036_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5434	036	0	1	04	01	H5434_036_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5434	036	0	1	04	01	H5434_036_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5435	024	0	1	09	04	H5435_024_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5435	024	0	1	09	04	H5435_024_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5435	024	0	1	09	04	H5435_024_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5435	024	0	1	09	04	H5435_024_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5435	024	0	1	09	04	H5435_024_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5439	011	0	1	04	01	H5439_011_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H5439	011	0	1	04	01	H5439_011_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5439	011	0	1	04	01	H5439_011_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5439	011	0	1	04	01	H5439_011_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5439	011	0	1	04	01	H5439_011_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5439	011	0	1	04	01	H5439_011_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5439	015	0	1	04	01	H5439_015_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H5439	015	0	1	04	01	H5439_015_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5439	015	0	1	04	01	H5439_015_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5439	015	0	1	04	01	H5439_015_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5439	015	0	1	04	01	H5439_015_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5439	015	0	1	04	01	H5439_015_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5439	017	0	1	04	01	H5439_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H5439	017	0	1	04	01	H5439_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5439	017	0	1	04	01	H5439_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5439	017	0	1	04	01	H5439_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5439	017	0	1	04	01	H5439_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5439	017	0	1	04	01	H5439_017_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5439	018	0	1	04	01	H5439_018_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H5439	018	0	1	04	01	H5439_018_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5439	018	0	1	04	01	H5439_018_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5439	018	0	1	04	01	H5439_018_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5439	018	0	1	04	01	H5439_018_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5439	018	0	1	04	01	H5439_018_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5439	019	0	1	04	01	H5439_019_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H5439	019	0	1	04	01	H5439_019_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5439	019	0	1	04	01	H5439_019_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5439	019	0	1	04	01	H5439_019_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5439	019	0	1	04	01	H5439_019_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5439	019	0	1	04	01	H5439_019_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5447	001	0	1	01	01	H5447_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5447	001	0	1	01	01	H5447_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5447	001	0	1	01	01	H5447_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5447	001	0	1	01	01	H5447_001_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5447	001	0	1	01	01	H5447_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5447	002	0	1	01	01	H5447_002_0	5	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5447	002	0	1	01	01	H5447_002_0	5	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5447	002	0	1	01	01	H5447_002_0	5	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5447	002	0	1	01	01	H5447_002_0	5	Non-Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5447	002	0	1	01	01	H5447_002_0	5	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5454	001	0	1	01	01	H5454_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5454	001	0	1	01	01	H5454_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5454	001	0	1	01	01	H5454_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5454	001	0	1	01	01	H5454_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H5454	001	0	1	01	01	H5454_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5454	002	0	1	01	01	H5454_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5454	002	0	1	01	01	H5454_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5454	002	0	1	01	01	H5454_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5454	002	0	1	01	01	H5454_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H5454	002	0	1	01	01	H5454_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5471	064	0	1	01	01	H5471_064_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	064	0	1	01	01	H5471_064_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	064	0	1	01	01	H5471_064_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	064	0	1	01	01	H5471_064_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	064	0	1	01	01	H5471_064_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	065	0	1	01	01	H5471_065_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	065	0	1	01	01	H5471_065_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	065	0	1	01	01	H5471_065_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	065	0	1	01	01	H5471_065_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	065	0	1	01	01	H5471_065_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	066	0	1	01	01	H5471_066_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	066	0	1	01	01	H5471_066_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	066	0	1	01	01	H5471_066_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	066	0	1	01	01	H5471_066_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	066	0	1	01	01	H5471_066_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	067	0	1	01	01	H5471_067_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	067	0	1	01	01	H5471_067_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	067	0	1	01	01	H5471_067_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	067	0	1	01	01	H5471_067_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	067	0	1	01	01	H5471_067_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	068	0	1	01	01	H5471_068_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	068	0	1	01	01	H5471_068_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	068	0	1	01	01	H5471_068_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	068	0	1	01	01	H5471_068_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	068	0	1	01	01	H5471_068_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	069	0	1	01	01	H5471_069_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	069	0	1	01	01	H5471_069_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	069	0	1	01	01	H5471_069_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	069	0	1	01	01	H5471_069_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	069	0	1	01	01	H5471_069_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	070	0	1	01	01	H5471_070_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	070	0	1	01	01	H5471_070_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	070	0	1	01	01	H5471_070_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	070	0	1	01	01	H5471_070_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	070	0	1	01	01	H5471_070_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	071	0	1	01	01	H5471_071_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	071	0	1	01	01	H5471_071_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	071	0	1	01	01	H5471_071_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	071	0	1	01	01	H5471_071_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	071	0	1	01	01	H5471_071_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	072	0	1	01	01	H5471_072_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	072	0	1	01	01	H5471_072_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	072	0	1	01	01	H5471_072_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	072	0	1	01	01	H5471_072_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	072	0	1	01	01	H5471_072_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	073	0	1	01	01	H5471_073_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	073	0	1	01	01	H5471_073_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	073	0	1	01	01	H5471_073_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	073	0	1	01	01	H5471_073_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	073	0	1	01	01	H5471_073_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	074	0	1	01	01	H5471_074_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	074	0	1	01	01	H5471_074_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	074	0	1	01	01	H5471_074_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	074	0	1	01	01	H5471_074_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	074	0	1	01	01	H5471_074_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	075	0	1	01	01	H5471_075_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	075	0	1	01	01	H5471_075_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	075	0	1	01	01	H5471_075_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	075	0	1	01	01	H5471_075_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	075	0	1	01	01	H5471_075_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	076	0	1	01	01	H5471_076_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	076	0	1	01	01	H5471_076_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	076	0	1	01	01	H5471_076_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	076	0	1	01	01	H5471_076_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	076	0	1	01	01	H5471_076_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	077	0	1	01	01	H5471_077_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	077	0	1	01	01	H5471_077_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	077	0	1	01	01	H5471_077_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	077	0	1	01	01	H5471_077_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	077	0	1	01	01	H5471_077_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	078	0	1	01	01	H5471_078_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	078	0	1	01	01	H5471_078_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	078	0	1	01	01	H5471_078_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	078	0	1	01	01	H5471_078_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	078	0	1	01	01	H5471_078_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	079	0	1	01	01	H5471_079_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	079	0	1	01	01	H5471_079_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	079	0	1	01	01	H5471_079_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	079	0	1	01	01	H5471_079_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	079	0	1	01	01	H5471_079_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	080	0	1	01	01	H5471_080_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	080	0	1	01	01	H5471_080_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	080	0	1	01	01	H5471_080_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	080	0	1	01	01	H5471_080_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	080	0	1	01	01	H5471_080_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	081	0	1	01	01	H5471_081_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	081	0	1	01	01	H5471_081_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	081	0	1	01	01	H5471_081_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	081	0	1	01	01	H5471_081_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	081	0	1	01	01	H5471_081_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	082	0	1	01	01	H5471_082_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	082	0	1	01	01	H5471_082_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	082	0	1	01	01	H5471_082_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	082	0	1	01	01	H5471_082_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	082	0	1	01	01	H5471_082_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	083	0	1	01	01	H5471_083_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	083	0	1	01	01	H5471_083_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	083	0	1	01	01	H5471_083_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	083	0	1	01	01	H5471_083_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	083	0	1	01	01	H5471_083_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	084	0	1	01	01	H5471_084_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	084	0	1	01	01	H5471_084_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	084	0	1	01	01	H5471_084_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	084	0	1	01	01	H5471_084_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	084	0	1	01	01	H5471_084_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	085	0	1	01	01	H5471_085_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	085	0	1	01	01	H5471_085_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	085	0	1	01	01	H5471_085_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	085	0	1	01	01	H5471_085_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	085	0	1	01	01	H5471_085_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	090	0	1	01	01	H5471_090_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	090	0	1	01	01	H5471_090_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	090	0	1	01	01	H5471_090_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	090	0	1	01	01	H5471_090_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	090	0	1	01	01	H5471_090_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	091	0	1	01	01	H5471_091_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	091	0	1	01	01	H5471_091_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	091	0	1	01	01	H5471_091_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	091	0	1	01	01	H5471_091_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	091	0	1	01	01	H5471_091_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	092	0	1	01	01	H5471_092_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	092	0	1	01	01	H5471_092_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	092	0	1	01	01	H5471_092_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	092	0	1	01	01	H5471_092_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	092	0	1	01	01	H5471_092_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	093	0	1	01	01	H5471_093_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	093	0	1	01	01	H5471_093_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	093	0	1	01	01	H5471_093_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	093	0	1	01	01	H5471_093_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	093	0	1	01	01	H5471_093_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	094	0	1	01	01	H5471_094_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	094	0	1	01	01	H5471_094_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	094	0	1	01	01	H5471_094_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	094	0	1	01	01	H5471_094_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	094	0	1	01	01	H5471_094_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	095	0	1	01	01	H5471_095_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	095	0	1	01	01	H5471_095_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	095	0	1	01	01	H5471_095_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	095	0	1	01	01	H5471_095_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	095	0	1	01	01	H5471_095_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	096	0	1	01	01	H5471_096_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	096	0	1	01	01	H5471_096_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	096	0	1	01	01	H5471_096_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	096	0	1	01	01	H5471_096_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	096	0	1	01	01	H5471_096_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	097	0	1	01	01	H5471_097_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5471	097	0	1	01	01	H5471_097_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	097	0	1	01	01	H5471_097_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	097	0	1	01	01	H5471_097_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	097	0	1	01	01	H5471_097_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	098	0	1	01	01	H5471_098_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	098	0	1	01	01	H5471_098_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	098	0	1	01	01	H5471_098_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	098	0	1	01	01	H5471_098_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	098	0	1	01	01	H5471_098_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	099	0	1	01	01	H5471_099_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	099	0	1	01	01	H5471_099_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	099	0	1	01	01	H5471_099_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	099	0	1	01	01	H5471_099_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	099	0	1	01	01	H5471_099_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	100	0	1	01	01	H5471_100_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	100	0	1	01	01	H5471_100_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	100	0	1	01	01	H5471_100_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	100	0	1	01	01	H5471_100_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	100	0	1	01	01	H5471_100_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	101	0	1	01	01	H5471_101_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	101	0	1	01	01	H5471_101_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	101	0	1	01	01	H5471_101_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	101	0	1	01	01	H5471_101_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	101	0	1	01	01	H5471_101_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	103	0	1	01	01	H5471_103_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	103	0	1	01	01	H5471_103_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	103	0	1	01	01	H5471_103_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	103	0	1	01	01	H5471_103_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	103	0	1	01	01	H5471_103_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	104	0	1	01	01	H5471_104_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	104	0	1	01	01	H5471_104_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	104	0	1	01	01	H5471_104_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	104	0	1	01	01	H5471_104_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	104	0	1	01	01	H5471_104_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5471	105	0	1	01	01	H5471_105_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	3						
H5471	105	0	1	01	01	H5471_105_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	1						
H5471	105	0	1	01	01	H5471_105_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5471	105	0	1	01	01	H5471_105_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5471	105	0	1	01	01	H5471_105_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5475	001	0	1	02	01	H5475_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	001	0	1	02	01	H5475_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	001	0	1	02	01	H5475_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	001	0	1	02	01	H5475_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	001	0	1	02	01	H5475_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	003	0	1	02	01	H5475_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	003	0	1	02	01	H5475_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	003	0	1	02	01	H5475_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	003	0	1	02	01	H5475_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	003	0	1	02	01	H5475_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	004	0	1	02	01	H5475_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	004	0	1	02	01	H5475_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	004	0	1	02	01	H5475_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	004	0	1	02	01	H5475_004_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	004	0	1	02	01	H5475_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	005	0	1	02	01	H5475_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	005	0	1	02	01	H5475_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	005	0	1	02	01	H5475_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	005	0	1	02	01	H5475_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	005	0	1	02	01	H5475_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	006	0	1	02	01	H5475_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	006	0	1	02	01	H5475_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	006	0	1	02	01	H5475_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	006	0	1	02	01	H5475_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	006	0	1	02	01	H5475_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	010	0	1	02	01	H5475_010_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	010	0	1	02	01	H5475_010_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	010	0	1	02	01	H5475_010_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	010	0	1	02	01	H5475_010_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	010	0	1	02	01	H5475_010_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	011	0	1	02	01	H5475_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	011	0	1	02	01	H5475_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	011	0	1	02	01	H5475_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	011	0	1	02	01	H5475_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	011	0	1	02	01	H5475_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	019	0	1	02	01	H5475_019_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	019	0	1	02	01	H5475_019_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	019	0	1	02	01	H5475_019_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	019	0	1	02	01	H5475_019_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	019	0	1	02	01	H5475_019_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	021	0	1	02	01	H5475_021_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	021	0	1	02	01	H5475_021_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	021	0	1	02	01	H5475_021_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	021	0	1	02	01	H5475_021_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	021	0	1	02	01	H5475_021_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	022	0	1	02	01	H5475_022_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	022	0	1	02	01	H5475_022_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	022	0	1	02	01	H5475_022_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	022	0	1	02	01	H5475_022_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	022	0	1	02	01	H5475_022_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	024	0	1	02	01	H5475_024_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	024	0	1	02	01	H5475_024_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	024	0	1	02	01	H5475_024_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	024	0	1	02	01	H5475_024_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	024	0	1	02	01	H5475_024_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	026	0	1	02	01	H5475_026_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	026	0	1	02	01	H5475_026_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	026	0	1	02	01	H5475_026_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	026	0	1	02	01	H5475_026_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	026	0	1	02	01	H5475_026_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	029	0	1	02	01	H5475_029_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H5475	029	0	1	02	01	H5475_029_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5475	029	0	1	02	01	H5475_029_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5475	029	0	1	02	01	H5475_029_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5475	029	0	1	02	01	H5475_029_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5475	029	0	1	02	01	H5475_029_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5475	030	0	1	02	01	H5475_030_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	030	0	1	02	01	H5475_030_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	030	0	1	02	01	H5475_030_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	030	0	1	02	01	H5475_030_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	030	0	1	02	01	H5475_030_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	031	0	1	01	01	H5475_031_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	031	0	1	01	01	H5475_031_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	031	0	1	01	01	H5475_031_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	031	0	1	01	01	H5475_031_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	031	0	1	01	01	H5475_031_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	032	0	1	01	01	H5475_032_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	032	0	1	01	01	H5475_032_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	032	0	1	01	01	H5475_032_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	032	0	1	01	01	H5475_032_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	032	0	1	01	01	H5475_032_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	033	0	1	01	01	H5475_033_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	033	0	1	01	01	H5475_033_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	033	0	1	01	01	H5475_033_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	033	0	1	01	01	H5475_033_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	033	0	1	01	01	H5475_033_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	034	0	1	01	01	H5475_034_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	034	0	1	01	01	H5475_034_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	034	0	1	01	01	H5475_034_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	034	0	1	01	01	H5475_034_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	034	0	1	01	01	H5475_034_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	035	0	1	02	01	H5475_035_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	035	0	1	02	01	H5475_035_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	035	0	1	02	01	H5475_035_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	035	0	1	02	01	H5475_035_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	035	0	1	02	01	H5475_035_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	036	0	1	02	01	H5475_036_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	036	0	1	02	01	H5475_036_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	036	0	1	02	01	H5475_036_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	036	0	1	02	01	H5475_036_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	036	0	1	02	01	H5475_036_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5475	037	0	1	02	01	H5475_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5475	037	0	1	02	01	H5475_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5475	037	0	1	02	01	H5475_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5475	037	0	1	02	01	H5475_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5475	037	0	1	02	01	H5475_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5496	005	0	1	01	01	H5496_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5496	005	0	1	01	01	H5496_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	3						
H5496	005	0	1	01	01	H5496_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5496	005	0	1	01	01	H5496_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5496	005	0	1	01	01	H5496_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5496	005	0	1	01	01	H5496_005_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H5496	007	0	1	01	01	H5496_007_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5496	007	0	1	01	01	H5496_007_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5496	007	0	1	01	01	H5496_007_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5496	007	0	1	01	01	H5496_007_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5496	007	0	1	01	01	H5496_007_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5496	009	0	1	01	01	H5496_009_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5496	009	0	1	01	01	H5496_009_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5496	009	0	1	01	01	H5496_009_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5496	009	0	1	01	01	H5496_009_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5496	009	0	1	01	01	H5496_009_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5496	011	0	1	01	01	H5496_011_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5496	011	0	1	01	01	H5496_011_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5496	011	0	1	01	01	H5496_011_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5496	011	0	1	01	01	H5496_011_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5496	011	0	1	01	01	H5496_011_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5496	012	0	1	01	01	H5496_012_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5496	012	0	1	01	01	H5496_012_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5496	012	0	1	01	01	H5496_012_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5496	012	0	1	01	01	H5496_012_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5496	012	0	1	01	01	H5496_012_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	012	0	1	04	01	H5521_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	012	0	1	04	01	H5521_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	012	0	1	04	01	H5521_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	012	0	1	04	01	H5521_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	012	0	1	04	01	H5521_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	013	0	1	04	01	H5521_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	013	0	1	04	01	H5521_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	013	0	1	04	01	H5521_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	015	0	1	04	01	H5521_015_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	015	0	1	04	01	H5521_015_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	015	0	1	04	01	H5521_015_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	015	0	1	04	01	H5521_015_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	015	0	1	04	01	H5521_015_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	016	0	1	04	01	H5521_016_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	016	0	1	04	01	H5521_016_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	016	0	1	04	01	H5521_016_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	016	0	1	04	01	H5521_016_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	016	0	1	04	01	H5521_016_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	020	0	1	04	01	H5521_020_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	020	0	1	04	01	H5521_020_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	020	0	1	04	01	H5521_020_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	020	0	1	04	01	H5521_020_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	020	0	1	04	01	H5521_020_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	022	0	1	04	01	H5521_022_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	022	0	1	04	01	H5521_022_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	022	0	1	04	01	H5521_022_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	022	0	1	04	01	H5521_022_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	022	0	1	04	01	H5521_022_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	027	0	1	04	01	H5521_027_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	027	0	1	04	01	H5521_027_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	027	0	1	04	01	H5521_027_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	027	0	1	04	01	H5521_027_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	027	0	1	04	01	H5521_027_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	033	0	1	04	01	H5521_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	033	0	1	04	01	H5521_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	033	0	1	04	01	H5521_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	033	0	1	04	01	H5521_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	033	0	1	04	01	H5521_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	037	0	1	04	01	H5521_037_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	037	0	1	04	01	H5521_037_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	037	0	1	04	01	H5521_037_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	037	0	1	04	01	H5521_037_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	037	0	1	04	01	H5521_037_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	040	0	1	04	01	H5521_040_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	040	0	1	04	01	H5521_040_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	040	0	1	04	01	H5521_040_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	040	0	1	04	01	H5521_040_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	040	0	1	04	01	H5521_040_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	053	0	1	04	01	H5521_053_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	053	0	1	04	01	H5521_053_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	053	0	1	04	01	H5521_053_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	053	0	1	04	01	H5521_053_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	053	0	1	04	01	H5521_053_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	055	0	1	04	01	H5521_055_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	055	0	1	04	01	H5521_055_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	055	0	1	04	01	H5521_055_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	055	0	1	04	01	H5521_055_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	055	0	1	04	01	H5521_055_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	056	0	1	04	01	H5521_056_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	056	0	1	04	01	H5521_056_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	056	0	1	04	01	H5521_056_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	056	0	1	04	01	H5521_056_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	056	0	1	04	01	H5521_056_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	057	0	1	04	01	H5521_057_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	057	0	1	04	01	H5521_057_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	057	0	1	04	01	H5521_057_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	057	0	1	04	01	H5521_057_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	057	0	1	04	01	H5521_057_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	076	0	1	04	01	H5521_076_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	076	0	1	04	01	H5521_076_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	076	0	1	04	01	H5521_076_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	076	0	1	04	01	H5521_076_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	076	0	1	04	01	H5521_076_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	077	0	1	04	01	H5521_077_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	077	0	1	04	01	H5521_077_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	077	0	1	04	01	H5521_077_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	077	0	1	04	01	H5521_077_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	077	0	1	04	01	H5521_077_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	081	0	1	04	01	H5521_081_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	081	0	1	04	01	H5521_081_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	081	0	1	04	01	H5521_081_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	081	0	1	04	01	H5521_081_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	081	0	1	04	01	H5521_081_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	082	0	1	04	01	H5521_082_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	082	0	1	04	01	H5521_082_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	082	0	1	04	01	H5521_082_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	082	0	1	04	01	H5521_082_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	082	0	1	04	01	H5521_082_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	083	0	1	04	01	H5521_083_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	083	0	1	04	01	H5521_083_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	083	0	1	04	01	H5521_083_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	083	0	1	04	01	H5521_083_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	083	0	1	04	01	H5521_083_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	084	0	1	04	01	H5521_084_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	084	0	1	04	01	H5521_084_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	084	0	1	04	01	H5521_084_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	084	0	1	04	01	H5521_084_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	084	0	1	04	01	H5521_084_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	085	0	1	04	01	H5521_085_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	085	0	1	04	01	H5521_085_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	085	0	1	04	01	H5521_085_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	085	0	1	04	01	H5521_085_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	085	0	1	04	01	H5521_085_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	086	0	1	04	01	H5521_086_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	086	0	1	04	01	H5521_086_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	086	0	1	04	01	H5521_086_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	086	0	1	04	01	H5521_086_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	086	0	1	04	01	H5521_086_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	087	0	1	04	01	H5521_087_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	087	0	1	04	01	H5521_087_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	087	0	1	04	01	H5521_087_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	087	0	1	04	01	H5521_087_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	087	0	1	04	01	H5521_087_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	088	0	1	04	01	H5521_088_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	088	0	1	04	01	H5521_088_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	088	0	1	04	01	H5521_088_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	088	0	1	04	01	H5521_088_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	088	0	1	04	01	H5521_088_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	089	0	1	04	01	H5521_089_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	089	0	1	04	01	H5521_089_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	089	0	1	04	01	H5521_089_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	089	0	1	04	01	H5521_089_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	089	0	1	04	01	H5521_089_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	090	0	1	04	01	H5521_090_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	090	0	1	04	01	H5521_090_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	090	0	1	04	01	H5521_090_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	090	0	1	04	01	H5521_090_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	090	0	1	04	01	H5521_090_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	091	0	1	04	01	H5521_091_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	091	0	1	04	01	H5521_091_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	091	0	1	04	01	H5521_091_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	091	0	1	04	01	H5521_091_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	091	0	1	04	01	H5521_091_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	095	0	1	04	01	H5521_095_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	095	0	1	04	01	H5521_095_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	095	0	1	04	01	H5521_095_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	095	0	1	04	01	H5521_095_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	095	0	1	04	01	H5521_095_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	099	0	1	04	01	H5521_099_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	099	0	1	04	01	H5521_099_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	099	0	1	04	01	H5521_099_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	099	0	1	04	01	H5521_099_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	099	0	1	04	01	H5521_099_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	100	0	1	04	01	H5521_100_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	100	0	1	04	01	H5521_100_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	100	0	1	04	01	H5521_100_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	100	0	1	04	01	H5521_100_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	100	0	1	04	01	H5521_100_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	101	0	1	04	01	H5521_101_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	101	0	1	04	01	H5521_101_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	101	0	1	04	01	H5521_101_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	101	0	1	04	01	H5521_101_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	101	0	1	04	01	H5521_101_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	102	0	1	04	01	H5521_102_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	102	0	1	04	01	H5521_102_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	102	0	1	04	01	H5521_102_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	102	0	1	04	01	H5521_102_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	102	0	1	04	01	H5521_102_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	110	0	1	04	01	H5521_110_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	110	0	1	04	01	H5521_110_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	110	0	1	04	01	H5521_110_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	110	0	1	04	01	H5521_110_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	110	0	1	04	01	H5521_110_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	116	0	1	04	01	H5521_116_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	116	0	1	04	01	H5521_116_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	116	0	1	04	01	H5521_116_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	116	0	1	04	01	H5521_116_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	116	0	1	04	01	H5521_116_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	117	0	1	04	01	H5521_117_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	117	0	1	04	01	H5521_117_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	117	0	1	04	01	H5521_117_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	117	0	1	04	01	H5521_117_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	117	0	1	04	01	H5521_117_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	118	0	1	04	01	H5521_118_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	118	0	1	04	01	H5521_118_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	118	0	1	04	01	H5521_118_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	118	0	1	04	01	H5521_118_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	118	0	1	04	01	H5521_118_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	119	0	1	04	01	H5521_119_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	119	0	1	04	01	H5521_119_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	119	0	1	04	01	H5521_119_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	119	0	1	04	01	H5521_119_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	119	0	1	04	01	H5521_119_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	120	0	1	04	01	H5521_120_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	120	0	1	04	01	H5521_120_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	120	0	1	04	01	H5521_120_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	120	0	1	04	01	H5521_120_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	120	0	1	04	01	H5521_120_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	121	0	1	04	01	H5521_121_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	121	0	1	04	01	H5521_121_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	121	0	1	04	01	H5521_121_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	121	0	1	04	01	H5521_121_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	121	0	1	04	01	H5521_121_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	122	0	1	04	01	H5521_122_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	122	0	1	04	01	H5521_122_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	122	0	1	04	01	H5521_122_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	122	0	1	04	01	H5521_122_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	122	0	1	04	01	H5521_122_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	123	0	1	04	01	H5521_123_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	123	0	1	04	01	H5521_123_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	123	0	1	04	01	H5521_123_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	123	0	1	04	01	H5521_123_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	123	0	1	04	01	H5521_123_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	124	0	1	04	01	H5521_124_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	124	0	1	04	01	H5521_124_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	124	0	1	04	01	H5521_124_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	124	0	1	04	01	H5521_124_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	124	0	1	04	01	H5521_124_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	125	0	1	04	01	H5521_125_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	125	0	1	04	01	H5521_125_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	125	0	1	04	01	H5521_125_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	125	0	1	04	01	H5521_125_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	125	0	1	04	01	H5521_125_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	127	0	1	04	01	H5521_127_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	127	0	1	04	01	H5521_127_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	127	0	1	04	01	H5521_127_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	127	0	1	04	01	H5521_127_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	127	0	1	04	01	H5521_127_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	128	0	1	04	01	H5521_128_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	128	0	1	04	01	H5521_128_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	128	0	1	04	01	H5521_128_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	128	0	1	04	01	H5521_128_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	128	0	1	04	01	H5521_128_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	134	0	1	04	01	H5521_134_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	134	0	1	04	01	H5521_134_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	134	0	1	04	01	H5521_134_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	134	0	1	04	01	H5521_134_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	134	0	1	04	01	H5521_134_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	139	0	1	04	01	H5521_139_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	139	0	1	04	01	H5521_139_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	139	0	1	04	01	H5521_139_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	139	0	1	04	01	H5521_139_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	139	0	1	04	01	H5521_139_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	140	0	1	04	01	H5521_140_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	140	0	1	04	01	H5521_140_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	140	0	1	04	01	H5521_140_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	140	0	1	04	01	H5521_140_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	140	0	1	04	01	H5521_140_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	141	0	1	04	01	H5521_141_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	141	0	1	04	01	H5521_141_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	141	0	1	04	01	H5521_141_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	141	0	1	04	01	H5521_141_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	141	0	1	04	01	H5521_141_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	142	0	1	04	01	H5521_142_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	142	0	1	04	01	H5521_142_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	142	0	1	04	01	H5521_142_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	143	0	1	04	01	H5521_143_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	143	0	1	04	01	H5521_143_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	143	0	1	04	01	H5521_143_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	143	0	1	04	01	H5521_143_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	143	0	1	04	01	H5521_143_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	144	0	1	04	01	H5521_144_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	144	0	1	04	01	H5521_144_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	144	0	1	04	01	H5521_144_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	150	0	1	04	01	H5521_150_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	150	0	1	04	01	H5521_150_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	150	0	1	04	01	H5521_150_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	150	0	1	04	01	H5521_150_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	150	0	1	04	01	H5521_150_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	154	0	1	04	01	H5521_154_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	154	0	1	04	01	H5521_154_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	154	0	1	04	01	H5521_154_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	154	0	1	04	01	H5521_154_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	154	0	1	04	01	H5521_154_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	156	0	1	04	01	H5521_156_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	156	0	1	04	01	H5521_156_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	156	0	1	04	01	H5521_156_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	156	0	1	04	01	H5521_156_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	156	0	1	04	01	H5521_156_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	157	0	1	04	01	H5521_157_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	157	0	1	04	01	H5521_157_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	157	0	1	04	01	H5521_157_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	157	0	1	04	01	H5521_157_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	157	0	1	04	01	H5521_157_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	159	0	1	04	01	H5521_159_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	159	0	1	04	01	H5521_159_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	159	0	1	04	01	H5521_159_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	159	0	1	04	01	H5521_159_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	159	0	1	04	01	H5521_159_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	160	0	1	04	01	H5521_160_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	160	0	1	04	01	H5521_160_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	160	0	1	04	01	H5521_160_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	160	0	1	04	01	H5521_160_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	160	0	1	04	01	H5521_160_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	168	0	1	04	01	H5521_168_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	168	0	1	04	01	H5521_168_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	168	0	1	04	01	H5521_168_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	168	0	1	04	01	H5521_168_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	168	0	1	04	01	H5521_168_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	169	0	1	04	01	H5521_169_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	169	0	1	04	01	H5521_169_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	169	0	1	04	01	H5521_169_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	169	0	1	04	01	H5521_169_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	169	0	1	04	01	H5521_169_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	170	0	1	04	01	H5521_170_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	170	0	1	04	01	H5521_170_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	170	0	1	04	01	H5521_170_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	170	0	1	04	01	H5521_170_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	170	0	1	04	01	H5521_170_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	171	0	1	04	01	H5521_171_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	171	0	1	04	01	H5521_171_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	171	0	1	04	01	H5521_171_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	171	0	1	04	01	H5521_171_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	171	0	1	04	01	H5521_171_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	177	0	1	04	01	H5521_177_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	177	0	1	04	01	H5521_177_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	177	0	1	04	01	H5521_177_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	177	0	1	04	01	H5521_177_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	177	0	1	04	01	H5521_177_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	178	0	1	04	01	H5521_178_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	178	0	1	04	01	H5521_178_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	178	0	1	04	01	H5521_178_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	178	0	1	04	01	H5521_178_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	178	0	1	04	01	H5521_178_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	184	0	1	04	01	H5521_184_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	184	0	1	04	01	H5521_184_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	184	0	1	04	01	H5521_184_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	184	0	1	04	01	H5521_184_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	184	0	1	04	01	H5521_184_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	187	0	1	04	01	H5521_187_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	187	0	1	04	01	H5521_187_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	187	0	1	04	01	H5521_187_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	187	0	1	04	01	H5521_187_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	187	0	1	04	01	H5521_187_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	190	0	1	04	01	H5521_190_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	190	0	1	04	01	H5521_190_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	190	0	1	04	01	H5521_190_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	190	0	1	04	01	H5521_190_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	190	0	1	04	01	H5521_190_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	194	0	1	04	01	H5521_194_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	194	0	1	04	01	H5521_194_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	194	0	1	04	01	H5521_194_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	194	0	1	04	01	H5521_194_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	194	0	1	04	01	H5521_194_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	195	0	1	04	01	H5521_195_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	195	0	1	04	01	H5521_195_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	195	0	1	04	01	H5521_195_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	195	0	1	04	01	H5521_195_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	195	0	1	04	01	H5521_195_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	196	0	1	04	01	H5521_196_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	196	0	1	04	01	H5521_196_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	196	0	1	04	01	H5521_196_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	196	0	1	04	01	H5521_196_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	196	0	1	04	01	H5521_196_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	197	0	1	04	01	H5521_197_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	197	0	1	04	01	H5521_197_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	197	0	1	04	01	H5521_197_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	197	0	1	04	01	H5521_197_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	197	0	1	04	01	H5521_197_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	200	0	1	04	01	H5521_200_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	200	0	1	04	01	H5521_200_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	200	0	1	04	01	H5521_200_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	200	0	1	04	01	H5521_200_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	200	0	1	04	01	H5521_200_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	205	0	1	04	01	H5521_205_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	205	0	1	04	01	H5521_205_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	205	0	1	04	01	H5521_205_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	205	0	1	04	01	H5521_205_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	205	0	1	04	01	H5521_205_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	206	0	1	04	01	H5521_206_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	206	0	1	04	01	H5521_206_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	206	0	1	04	01	H5521_206_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	206	0	1	04	01	H5521_206_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	206	0	1	04	01	H5521_206_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	207	0	1	04	01	H5521_207_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	207	0	1	04	01	H5521_207_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	207	0	1	04	01	H5521_207_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	207	0	1	04	01	H5521_207_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	207	0	1	04	01	H5521_207_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	211	0	1	04	01	H5521_211_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	211	0	1	04	01	H5521_211_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	211	0	1	04	01	H5521_211_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	211	0	1	04	01	H5521_211_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	211	0	1	04	01	H5521_211_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	212	0	1	04	01	H5521_212_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	212	0	1	04	01	H5521_212_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	212	0	1	04	01	H5521_212_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	212	0	1	04	01	H5521_212_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	212	0	1	04	01	H5521_212_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	214	0	1	04	01	H5521_214_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	214	0	1	04	01	H5521_214_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	214	0	1	04	01	H5521_214_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	214	0	1	04	01	H5521_214_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	214	0	1	04	01	H5521_214_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	215	0	1	04	01	H5521_215_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	215	0	1	04	01	H5521_215_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	215	0	1	04	01	H5521_215_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	215	0	1	04	01	H5521_215_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	215	0	1	04	01	H5521_215_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	216	0	1	04	01	H5521_216_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	216	0	1	04	01	H5521_216_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	216	0	1	04	01	H5521_216_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	216	0	1	04	01	H5521_216_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	216	0	1	04	01	H5521_216_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	217	0	1	04	01	H5521_217_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	217	0	1	04	01	H5521_217_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	217	0	1	04	01	H5521_217_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	217	0	1	04	01	H5521_217_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	217	0	1	04	01	H5521_217_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	218	0	1	04	01	H5521_218_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	218	0	1	04	01	H5521_218_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	218	0	1	04	01	H5521_218_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	218	0	1	04	01	H5521_218_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	218	0	1	04	01	H5521_218_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	219	0	1	04	01	H5521_219_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	219	0	1	04	01	H5521_219_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	219	0	1	04	01	H5521_219_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	219	0	1	04	01	H5521_219_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	219	0	1	04	01	H5521_219_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	220	0	1	04	01	H5521_220_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	220	0	1	04	01	H5521_220_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	220	0	1	04	01	H5521_220_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	220	0	1	04	01	H5521_220_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	220	0	1	04	01	H5521_220_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	221	0	1	04	01	H5521_221_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	221	0	1	04	01	H5521_221_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	221	0	1	04	01	H5521_221_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	221	0	1	04	01	H5521_221_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	221	0	1	04	01	H5521_221_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	222	0	1	04	01	H5521_222_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	222	0	1	04	01	H5521_222_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	222	0	1	04	01	H5521_222_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	222	0	1	04	01	H5521_222_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	222	0	1	04	01	H5521_222_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	223	0	1	04	01	H5521_223_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	223	0	1	04	01	H5521_223_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	223	0	1	04	01	H5521_223_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	223	0	1	04	01	H5521_223_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	223	0	1	04	01	H5521_223_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	224	0	1	04	01	H5521_224_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	224	0	1	04	01	H5521_224_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	224	0	1	04	01	H5521_224_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	224	0	1	04	01	H5521_224_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	224	0	1	04	01	H5521_224_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	226	0	1	04	01	H5521_226_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	226	0	1	04	01	H5521_226_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	226	0	1	04	01	H5521_226_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	226	0	1	04	01	H5521_226_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	226	0	1	04	01	H5521_226_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	227	0	1	04	01	H5521_227_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	227	0	1	04	01	H5521_227_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	227	0	1	04	01	H5521_227_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	227	0	1	04	01	H5521_227_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	227	0	1	04	01	H5521_227_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	228	0	1	04	01	H5521_228_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	228	0	1	04	01	H5521_228_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	228	0	1	04	01	H5521_228_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	228	0	1	04	01	H5521_228_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	228	0	1	04	01	H5521_228_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	230	0	1	04	01	H5521_230_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	230	0	1	04	01	H5521_230_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	230	0	1	04	01	H5521_230_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	230	0	1	04	01	H5521_230_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	230	0	1	04	01	H5521_230_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	231	0	1	04	01	H5521_231_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	231	0	1	04	01	H5521_231_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	231	0	1	04	01	H5521_231_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	231	0	1	04	01	H5521_231_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	231	0	1	04	01	H5521_231_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	232	0	1	04	01	H5521_232_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	232	0	1	04	01	H5521_232_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	232	0	1	04	01	H5521_232_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	232	0	1	04	01	H5521_232_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	232	0	1	04	01	H5521_232_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	233	0	1	04	01	H5521_233_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	233	0	1	04	01	H5521_233_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	233	0	1	04	01	H5521_233_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	233	0	1	04	01	H5521_233_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	233	0	1	04	01	H5521_233_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	234	0	1	04	01	H5521_234_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	234	0	1	04	01	H5521_234_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	234	0	1	04	01	H5521_234_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	234	0	1	04	01	H5521_234_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	234	0	1	04	01	H5521_234_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	236	0	1	04	01	H5521_236_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	236	0	1	04	01	H5521_236_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	236	0	1	04	01	H5521_236_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	236	0	1	04	01	H5521_236_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	236	0	1	04	01	H5521_236_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	237	0	1	04	01	H5521_237_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	237	0	1	04	01	H5521_237_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	237	0	1	04	01	H5521_237_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	237	0	1	04	01	H5521_237_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	237	0	1	04	01	H5521_237_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	239	0	1	04	01	H5521_239_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	239	0	1	04	01	H5521_239_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	239	0	1	04	01	H5521_239_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	239	0	1	04	01	H5521_239_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	239	0	1	04	01	H5521_239_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	243	0	1	04	01	H5521_243_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	243	0	1	04	01	H5521_243_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	243	0	1	04	01	H5521_243_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	243	0	1	04	01	H5521_243_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	243	0	1	04	01	H5521_243_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	244	0	1	04	01	H5521_244_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	244	0	1	04	01	H5521_244_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	244	0	1	04	01	H5521_244_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	244	0	1	04	01	H5521_244_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	244	0	1	04	01	H5521_244_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	245	0	1	04	01	H5521_245_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	245	0	1	04	01	H5521_245_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	245	0	1	04	01	H5521_245_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	245	0	1	04	01	H5521_245_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	245	0	1	04	01	H5521_245_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	246	0	1	04	01	H5521_246_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	246	0	1	04	01	H5521_246_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	246	0	1	04	01	H5521_246_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	246	0	1	04	01	H5521_246_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	246	0	1	04	01	H5521_246_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	247	0	1	04	01	H5521_247_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	247	0	1	04	01	H5521_247_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	247	0	1	04	01	H5521_247_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	247	0	1	04	01	H5521_247_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	247	0	1	04	01	H5521_247_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	249	0	1	04	01	H5521_249_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	249	0	1	04	01	H5521_249_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	249	0	1	04	01	H5521_249_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	249	0	1	04	01	H5521_249_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	249	0	1	04	01	H5521_249_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	250	0	1	04	01	H5521_250_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	250	0	1	04	01	H5521_250_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	250	0	1	04	01	H5521_250_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	250	0	1	04	01	H5521_250_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	250	0	1	04	01	H5521_250_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	251	0	1	04	01	H5521_251_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	251	0	1	04	01	H5521_251_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	251	0	1	04	01	H5521_251_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	251	0	1	04	01	H5521_251_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	251	0	1	04	01	H5521_251_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	252	0	1	04	01	H5521_252_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	252	0	1	04	01	H5521_252_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	252	0	1	04	01	H5521_252_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	252	0	1	04	01	H5521_252_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	252	0	1	04	01	H5521_252_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	253	0	1	04	01	H5521_253_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	253	0	1	04	01	H5521_253_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	253	0	1	04	01	H5521_253_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	253	0	1	04	01	H5521_253_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	253	0	1	04	01	H5521_253_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	254	0	1	04	01	H5521_254_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	254	0	1	04	01	H5521_254_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	254	0	1	04	01	H5521_254_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	254	0	1	04	01	H5521_254_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	254	0	1	04	01	H5521_254_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	259	0	1	04	01	H5521_259_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	259	0	1	04	01	H5521_259_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	259	0	1	04	01	H5521_259_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	259	0	1	04	01	H5521_259_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	259	0	1	04	01	H5521_259_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	260	0	1	04	01	H5521_260_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	260	0	1	04	01	H5521_260_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	260	0	1	04	01	H5521_260_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	260	0	1	04	01	H5521_260_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	260	0	1	04	01	H5521_260_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	261	0	1	04	01	H5521_261_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5521	261	0	1	04	01	H5521_261_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5521	261	0	1	04	01	H5521_261_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	261	0	1	04	01	H5521_261_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	261	0	1	04	01	H5521_261_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	262	0	1	04	01	H5521_262_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	262	0	1	04	01	H5521_262_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	262	0	1	04	01	H5521_262_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	262	0	1	04	01	H5521_262_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	262	0	1	04	01	H5521_262_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	263	0	1	04	01	H5521_263_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	263	0	1	04	01	H5521_263_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	263	0	1	04	01	H5521_263_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	263	0	1	04	01	H5521_263_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	263	0	1	04	01	H5521_263_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	266	0	1	04	01	H5521_266_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	266	0	1	04	01	H5521_266_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	266	0	1	04	01	H5521_266_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	266	0	1	04	01	H5521_266_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	266	0	1	04	01	H5521_266_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	267	0	1	04	01	H5521_267_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	267	0	1	04	01	H5521_267_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	267	0	1	04	01	H5521_267_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	267	0	1	04	01	H5521_267_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	267	0	1	04	01	H5521_267_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	268	0	1	04	01	H5521_268_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	268	0	1	04	01	H5521_268_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	268	0	1	04	01	H5521_268_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	268	0	1	04	01	H5521_268_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	268	0	1	04	01	H5521_268_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	269	0	1	04	01	H5521_269_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	269	0	1	04	01	H5521_269_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	269	0	1	04	01	H5521_269_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	269	0	1	04	01	H5521_269_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	269	0	1	04	01	H5521_269_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	270	0	1	04	01	H5521_270_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	270	0	1	04	01	H5521_270_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	270	0	1	04	01	H5521_270_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	270	0	1	04	01	H5521_270_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	270	0	1	04	01	H5521_270_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	271	0	1	04	01	H5521_271_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	271	0	1	04	01	H5521_271_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	271	0	1	04	01	H5521_271_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	271	0	1	04	01	H5521_271_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	271	0	1	04	01	H5521_271_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	272	0	1	04	01	H5521_272_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	272	0	1	04	01	H5521_272_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	272	0	1	04	01	H5521_272_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	272	0	1	04	01	H5521_272_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	272	0	1	04	01	H5521_272_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	273	0	1	04	01	H5521_273_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	273	0	1	04	01	H5521_273_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	273	0	1	04	01	H5521_273_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	273	0	1	04	01	H5521_273_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	273	0	1	04	01	H5521_273_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	275	0	1	04	01	H5521_275_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	275	0	1	04	01	H5521_275_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	275	0	1	04	01	H5521_275_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	275	0	1	04	01	H5521_275_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	275	0	1	04	01	H5521_275_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	277	0	1	04	01	H5521_277_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	277	0	1	04	01	H5521_277_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	277	0	1	04	01	H5521_277_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	277	0	1	04	01	H5521_277_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	277	0	1	04	01	H5521_277_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	278	0	1	04	01	H5521_278_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	278	0	1	04	01	H5521_278_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	278	0	1	04	01	H5521_278_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	278	0	1	04	01	H5521_278_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	278	0	1	04	01	H5521_278_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	280	0	1	04	01	H5521_280_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	280	0	1	04	01	H5521_280_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	280	0	1	04	01	H5521_280_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	280	0	1	04	01	H5521_280_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	280	0	1	04	01	H5521_280_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	281	0	1	04	01	H5521_281_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	281	0	1	04	01	H5521_281_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	281	0	1	04	01	H5521_281_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	281	0	1	04	01	H5521_281_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	281	0	1	04	01	H5521_281_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	282	0	1	04	01	H5521_282_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5521	282	0	1	04	01	H5521_282_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5521	282	0	1	04	01	H5521_282_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	282	0	1	04	01	H5521_282_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	282	0	1	04	01	H5521_282_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	283	0	1	04	01	H5521_283_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5521	283	0	1	04	01	H5521_283_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5521	283	0	1	04	01	H5521_283_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	283	0	1	04	01	H5521_283_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	283	0	1	04	01	H5521_283_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	284	0	1	04	01	H5521_284_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	284	0	1	04	01	H5521_284_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	284	0	1	04	01	H5521_284_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	284	0	1	04	01	H5521_284_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	284	0	1	04	01	H5521_284_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	285	0	1	04	01	H5521_285_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	285	0	1	04	01	H5521_285_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	285	0	1	04	01	H5521_285_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	285	0	1	04	01	H5521_285_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	285	0	1	04	01	H5521_285_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	288	0	1	04	01	H5521_288_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	288	0	1	04	01	H5521_288_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	288	0	1	04	01	H5521_288_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	288	0	1	04	01	H5521_288_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	288	0	1	04	01	H5521_288_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	289	0	1	04	01	H5521_289_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	289	0	1	04	01	H5521_289_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	289	0	1	04	01	H5521_289_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	289	0	1	04	01	H5521_289_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	289	0	1	04	01	H5521_289_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	290	0	1	04	01	H5521_290_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	290	0	1	04	01	H5521_290_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	290	0	1	04	01	H5521_290_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	290	0	1	04	01	H5521_290_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	290	0	1	04	01	H5521_290_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	292	0	1	04	01	H5521_292_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	292	0	1	04	01	H5521_292_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	292	0	1	04	01	H5521_292_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	292	0	1	04	01	H5521_292_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	292	0	1	04	01	H5521_292_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	293	0	1	04	01	H5521_293_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	293	0	1	04	01	H5521_293_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	293	0	1	04	01	H5521_293_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	293	0	1	04	01	H5521_293_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	293	0	1	04	01	H5521_293_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	294	0	1	04	01	H5521_294_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	294	0	1	04	01	H5521_294_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	294	0	1	04	01	H5521_294_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	294	0	1	04	01	H5521_294_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	294	0	1	04	01	H5521_294_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	295	0	1	04	01	H5521_295_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	295	0	1	04	01	H5521_295_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	295	0	1	04	01	H5521_295_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	295	0	1	04	01	H5521_295_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	295	0	1	04	01	H5521_295_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	298	0	1	04	01	H5521_298_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	298	0	1	04	01	H5521_298_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	298	0	1	04	01	H5521_298_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	298	0	1	04	01	H5521_298_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	298	0	1	04	01	H5521_298_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	299	0	1	04	01	H5521_299_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	299	0	1	04	01	H5521_299_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	299	0	1	04	01	H5521_299_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	299	0	1	04	01	H5521_299_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	299	0	1	04	01	H5521_299_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	300	0	1	04	01	H5521_300_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	300	0	1	04	01	H5521_300_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	300	0	1	04	01	H5521_300_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	300	0	1	04	01	H5521_300_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	300	0	1	04	01	H5521_300_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	301	0	1	04	01	H5521_301_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	301	0	1	04	01	H5521_301_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	301	0	1	04	01	H5521_301_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	301	0	1	04	01	H5521_301_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	301	0	1	04	01	H5521_301_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	302	0	1	04	01	H5521_302_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	302	0	1	04	01	H5521_302_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	302	0	1	04	01	H5521_302_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	302	0	1	04	01	H5521_302_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	302	0	1	04	01	H5521_302_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	303	0	1	04	01	H5521_303_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	303	0	1	04	01	H5521_303_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	303	0	1	04	01	H5521_303_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	303	0	1	04	01	H5521_303_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	303	0	1	04	01	H5521_303_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	304	0	1	04	01	H5521_304_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	304	0	1	04	01	H5521_304_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	304	0	1	04	01	H5521_304_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	304	0	1	04	01	H5521_304_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	304	0	1	04	01	H5521_304_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	305	0	1	04	01	H5521_305_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	305	0	1	04	01	H5521_305_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	305	0	1	04	01	H5521_305_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	305	0	1	04	01	H5521_305_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	305	0	1	04	01	H5521_305_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	307	0	1	04	01	H5521_307_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	307	0	1	04	01	H5521_307_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	307	0	1	04	01	H5521_307_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	307	0	1	04	01	H5521_307_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	307	0	1	04	01	H5521_307_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	309	0	1	04	01	H5521_309_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	309	0	1	04	01	H5521_309_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	309	0	1	04	01	H5521_309_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	309	0	1	04	01	H5521_309_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	309	0	1	04	01	H5521_309_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	310	0	1	04	01	H5521_310_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	310	0	1	04	01	H5521_310_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	310	0	1	04	01	H5521_310_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	310	0	1	04	01	H5521_310_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	310	0	1	04	01	H5521_310_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	311	0	1	04	01	H5521_311_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	311	0	1	04	01	H5521_311_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	311	0	1	04	01	H5521_311_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	311	0	1	04	01	H5521_311_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	311	0	1	04	01	H5521_311_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	312	0	1	04	01	H5521_312_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	312	0	1	04	01	H5521_312_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	312	0	1	04	01	H5521_312_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	312	0	1	04	01	H5521_312_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	312	0	1	04	01	H5521_312_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	313	0	1	04	01	H5521_313_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	313	0	1	04	01	H5521_313_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	313	0	1	04	01	H5521_313_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	313	0	1	04	01	H5521_313_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	313	0	1	04	01	H5521_313_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	314	0	1	04	01	H5521_314_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	314	0	1	04	01	H5521_314_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	314	0	1	04	01	H5521_314_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	314	0	1	04	01	H5521_314_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	314	0	1	04	01	H5521_314_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	318	0	1	04	01	H5521_318_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	318	0	1	04	01	H5521_318_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	318	0	1	04	01	H5521_318_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	318	0	1	04	01	H5521_318_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	318	0	1	04	01	H5521_318_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	319	0	1	04	01	H5521_319_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	319	0	1	04	01	H5521_319_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	319	0	1	04	01	H5521_319_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	319	0	1	04	01	H5521_319_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	319	0	1	04	01	H5521_319_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	321	0	1	04	01	H5521_321_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	321	0	1	04	01	H5521_321_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	321	0	1	04	01	H5521_321_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	321	0	1	04	01	H5521_321_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	321	0	1	04	01	H5521_321_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	326	0	1	04	01	H5521_326_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	326	0	1	04	01	H5521_326_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	326	0	1	04	01	H5521_326_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	326	0	1	04	01	H5521_326_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	326	0	1	04	01	H5521_326_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5521	328	0	1	04	01	H5521_328_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5521	328	0	1	04	01	H5521_328_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5521	328	0	1	04	01	H5521_328_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5521	328	0	1	04	01	H5521_328_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5521	328	0	1	04	01	H5521_328_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5522	001	0	1	04	01	H5522_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5522	001	0	1	04	01	H5522_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5522	001	0	1	04	01	H5522_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5522	001	0	1	04	01	H5522_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5522	001	0	1	04	01	H5522_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5522	002	0	1	04	01	H5522_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5522	002	0	1	04	01	H5522_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5522	002	0	1	04	01	H5522_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5522	002	0	1	04	01	H5522_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5522	002	0	1	04	01	H5522_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5522	004	0	1	04	01	H5522_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5522	004	0	1	04	01	H5522_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5522	004	0	1	04	01	H5522_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5522	004	0	1	04	01	H5522_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5522	004	0	1	04	01	H5522_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5522	005	0	1	04	01	H5522_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5522	005	0	1	04	01	H5522_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5522	005	0	1	04	01	H5522_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5522	005	0	1	04	01	H5522_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5522	005	0	1	04	01	H5522_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5522	013	0	1	04	01	H5522_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5522	013	0	1	04	01	H5522_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5522	013	0	1	04	01	H5522_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5522	013	0	1	04	01	H5522_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5522	013	0	1	04	01	H5522_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5522	014	0	1	04	01	H5522_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5522	014	0	1	04	01	H5522_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5522	014	0	1	04	01	H5522_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5522	014	0	1	04	01	H5522_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5522	014	0	1	04	01	H5522_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5522	017	0	1	04	01	H5522_017_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5522	017	0	1	04	01	H5522_017_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5522	017	0	1	04	01	H5522_017_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5522	017	0	1	04	01	H5522_017_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5522	017	0	1	04	01	H5522_017_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5522	018	0	1	04	01	H5522_018_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H5522	018	0	1	04	01	H5522_018_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5522	018	0	1	04	01	H5522_018_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5522	018	0	1	04	01	H5522_018_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5522	018	0	1	04	01	H5522_018_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	004	0	1	04	01	H5525_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	004	0	1	04	01	H5525_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	004	0	1	04	01	H5525_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	004	0	1	04	01	H5525_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	004	0	1	04	01	H5525_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	005	0	1	04	01	H5525_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	005	0	1	04	01	H5525_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	005	0	1	04	01	H5525_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	005	0	1	04	01	H5525_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	005	0	1	04	01	H5525_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	006	0	1	04	01	H5525_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	006	0	1	04	01	H5525_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	006	0	1	04	01	H5525_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	006	0	1	04	01	H5525_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	006	0	1	04	01	H5525_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	007	0	1	04	01	H5525_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	007	0	1	04	01	H5525_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	007	0	1	04	01	H5525_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	007	0	1	04	01	H5525_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	007	0	1	04	01	H5525_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	008	0	1	04	01	H5525_008_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	008	0	1	04	01	H5525_008_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	008	0	1	04	01	H5525_008_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	008	0	1	04	01	H5525_008_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	008	0	1	04	01	H5525_008_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	015	0	1	04	01	H5525_015_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	015	0	1	04	01	H5525_015_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	015	0	1	04	01	H5525_015_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	015	0	1	04	01	H5525_015_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	015	0	1	04	01	H5525_015_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	017	0	1	04	01	H5525_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	017	0	1	04	01	H5525_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	017	0	1	04	01	H5525_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	017	0	1	04	01	H5525_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	017	0	1	04	01	H5525_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	020	0	1	04	01	H5525_020_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	020	0	1	04	01	H5525_020_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	020	0	1	04	01	H5525_020_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	020	0	1	04	01	H5525_020_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	020	0	1	04	01	H5525_020_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	022	0	1	04	01	H5525_022_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	022	0	1	04	01	H5525_022_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	022	0	1	04	01	H5525_022_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	022	0	1	04	01	H5525_022_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	022	0	1	04	01	H5525_022_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	023	0	1	04	01	H5525_023_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	023	0	1	04	01	H5525_023_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	023	0	1	04	01	H5525_023_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	023	0	1	04	01	H5525_023_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	023	0	1	04	01	H5525_023_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	024	0	1	04	01	H5525_024_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	024	0	1	04	01	H5525_024_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	024	0	1	04	01	H5525_024_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	024	0	1	04	01	H5525_024_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	024	0	1	04	01	H5525_024_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	026	0	1	04	01	H5525_026_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	026	0	1	04	01	H5525_026_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	026	0	1	04	01	H5525_026_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	026	0	1	04	01	H5525_026_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	026	0	1	04	01	H5525_026_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	027	0	1	04	01	H5525_027_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	027	0	1	04	01	H5525_027_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	027	0	1	04	01	H5525_027_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	027	0	1	04	01	H5525_027_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	027	0	1	04	01	H5525_027_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	030	0	1	04	01	H5525_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	030	0	1	04	01	H5525_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	030	0	1	04	01	H5525_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	030	0	1	04	01	H5525_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	030	0	1	04	01	H5525_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	034	0	1	04	01	H5525_034_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	034	0	1	04	01	H5525_034_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	034	0	1	04	01	H5525_034_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	034	0	1	04	01	H5525_034_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	034	0	1	04	01	H5525_034_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	035	0	1	04	01	H5525_035_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	035	0	1	04	01	H5525_035_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	035	0	1	04	01	H5525_035_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	035	0	1	04	01	H5525_035_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	035	0	1	04	01	H5525_035_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	036	0	1	04	01	H5525_036_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	036	0	1	04	01	H5525_036_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	036	0	1	04	01	H5525_036_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	036	0	1	04	01	H5525_036_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	036	0	1	04	01	H5525_036_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	037	0	1	04	01	H5525_037_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	037	0	1	04	01	H5525_037_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	037	0	1	04	01	H5525_037_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	037	0	1	04	01	H5525_037_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	037	0	1	04	01	H5525_037_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	038	0	1	04	01	H5525_038_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	038	0	1	04	01	H5525_038_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	038	0	1	04	01	H5525_038_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	038	0	1	04	01	H5525_038_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	038	0	1	04	01	H5525_038_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	039	0	1	04	01	H5525_039_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	039	0	1	04	01	H5525_039_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	039	0	1	04	01	H5525_039_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	039	0	1	04	01	H5525_039_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	039	0	1	04	01	H5525_039_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	040	0	1	04	01	H5525_040_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	040	0	1	04	01	H5525_040_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	040	0	1	04	01	H5525_040_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	040	0	1	04	01	H5525_040_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	040	0	1	04	01	H5525_040_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	041	0	1	04	01	H5525_041_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	041	0	1	04	01	H5525_041_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	041	0	1	04	01	H5525_041_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	041	0	1	04	01	H5525_041_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	041	0	1	04	01	H5525_041_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	042	0	1	04	01	H5525_042_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	042	0	1	04	01	H5525_042_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	042	0	1	04	01	H5525_042_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	042	0	1	04	01	H5525_042_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	042	0	1	04	01	H5525_042_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	044	0	1	04	01	H5525_044_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	044	0	1	04	01	H5525_044_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	044	0	1	04	01	H5525_044_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	044	0	1	04	01	H5525_044_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	044	0	1	04	01	H5525_044_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	045	0	1	04	01	H5525_045_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	045	0	1	04	01	H5525_045_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	045	0	1	04	01	H5525_045_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	045	0	1	04	01	H5525_045_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	045	0	1	04	01	H5525_045_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	046	0	1	04	01	H5525_046_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	046	0	1	04	01	H5525_046_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	046	0	1	04	01	H5525_046_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	046	0	1	04	01	H5525_046_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	046	0	1	04	01	H5525_046_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	047	0	1	04	01	H5525_047_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	047	0	1	04	01	H5525_047_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	047	0	1	04	01	H5525_047_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	047	0	1	04	01	H5525_047_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	047	0	1	04	01	H5525_047_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	048	0	1	04	01	H5525_048_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	048	0	1	04	01	H5525_048_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	048	0	1	04	01	H5525_048_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	048	0	1	04	01	H5525_048_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	048	0	1	04	01	H5525_048_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5525	049	0	1	04	01	H5525_049_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5525	049	0	1	04	01	H5525_049_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5525	049	0	1	04	01	H5525_049_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5525	049	0	1	04	01	H5525_049_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5525	049	0	1	04	01	H5525_049_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5526	004	0	1	04	01	H5526_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5526	004	0	1	04	01	H5526_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5526	004	0	1	04	01	H5526_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5526	004	0	1	04	01	H5526_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5526	004	0	1	04	01	H5526_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5526	016	0	1	04	01	H5526_016_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5526	016	0	1	04	01	H5526_016_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5526	016	0	1	04	01	H5526_016_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5526	016	0	1	04	01	H5526_016_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5526	016	0	1	04	01	H5526_016_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5526	018	0	1	04	01	H5526_018_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5526	018	0	1	04	01	H5526_018_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5526	018	0	1	04	01	H5526_018_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5526	018	0	1	04	01	H5526_018_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5526	018	0	1	04	01	H5526_018_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5526	020	0	1	04	01	H5526_020_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5526	020	0	1	04	01	H5526_020_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5526	020	0	1	04	01	H5526_020_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5526	020	0	1	04	01	H5526_020_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5526	020	0	1	04	01	H5526_020_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5526	021	0	1	04	01	H5526_021_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5526	021	0	1	04	01	H5526_021_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5526	021	0	1	04	01	H5526_021_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5526	021	0	1	04	01	H5526_021_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5526	021	0	1	04	01	H5526_021_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5533	003	0	1	04	01	H5533_003_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5533	003	0	1	04	01	H5533_003_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5533	003	0	1	04	01	H5533_003_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5533	003	0	1	04	01	H5533_003_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5533	003	0	1	04	01	H5533_003_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5533	005	0	1	04	01	H5533_005_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5533	005	0	1	04	01	H5533_005_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5533	005	0	1	04	01	H5533_005_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5533	005	0	1	04	01	H5533_005_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5533	005	0	1	04	01	H5533_005_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5533	007	0	1	04	01	H5533_007_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5533	007	0	1	04	01	H5533_007_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5533	007	0	1	04	01	H5533_007_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5533	007	0	1	04	01	H5533_007_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5533	007	0	1	04	01	H5533_007_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5533	008	0	1	04	01	H5533_008_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5533	008	0	1	04	01	H5533_008_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5533	008	0	1	04	01	H5533_008_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5533	008	0	1	04	01	H5533_008_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5533	008	0	1	04	01	H5533_008_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5549	003	0	1	01	01	H5549_003_0	8	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5549	003	0	1	01	01	H5549_003_0	8	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5549	003	0	1	01	01	H5549_003_0	8	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5549	003	0	1	01	01	H5549_003_0	8	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5549	003	0	1	01	01	H5549_003_0	8	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5576	008	0	1	02	01	H5576_008_0	5	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5576	008	0	1	02	01	H5576_008_0	5	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5576	008	0	1	02	01	H5576_008_0	5	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5576	008	0	1	02	01	H5576_008_0	5	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5576	008	0	1	02	01	H5576_008_0	5	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H5576	017	1	1	02	01	H5576_017_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5576	017	1	1	02	01	H5576_017_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5576	017	1	1	02	01	H5576_017_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5576	017	1	1	02	01	H5576_017_1	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5576	017	1	1	02	01	H5576_017_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H5576	017	2	1	02	01	H5576_017_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5576	017	2	1	02	01	H5576_017_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5576	017	2	1	02	01	H5576_017_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5576	017	2	1	02	01	H5576_017_2	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5576	017	2	1	02	01	H5576_017_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H5576	018	1	1	02	01	H5576_018_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5576	018	1	1	02	01	H5576_018_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5576	018	1	1	02	01	H5576_018_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5576	018	1	1	02	01	H5576_018_1	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5576	018	1	1	02	01	H5576_018_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H5576	018	2	1	02	01	H5576_018_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5576	018	2	1	02	01	H5576_018_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5576	018	2	1	02	01	H5576_018_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5576	018	2	1	02	01	H5576_018_2	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5576	018	2	1	02	01	H5576_018_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H5576	019	0	1	02	01	H5576_019_0	7	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5576	019	0	1	02	01	H5576_019_0	7	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5576	019	0	1	02	01	H5576_019_0	7	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5576	019	0	1	02	01	H5576_019_0	7	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5576	019	0	1	02	01	H5576_019_0	7	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H5576	020	1	1	02	01	H5576_020_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5576	020	1	1	02	01	H5576_020_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5576	020	1	1	02	01	H5576_020_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5576	020	1	1	02	01	H5576_020_1	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5576	020	1	1	02	01	H5576_020_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H5576	020	2	1	02	01	H5576_020_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5576	020	2	1	02	01	H5576_020_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5576	020	2	1	02	01	H5576_020_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5576	020	2	1	02	01	H5576_020_2	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5576	020	2	1	02	01	H5576_020_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H5576	022	0	1	02	01	H5576_022_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5576	022	0	1	02	01	H5576_022_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5576	022	0	1	02	01	H5576_022_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5576	022	0	1	02	01	H5576_022_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5576	022	0	1	02	01	H5576_022_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5577	005	0	1	01	01	H5577_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5577	005	0	1	01	01	H5577_005_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5577	005	0	1	01	01	H5577_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5577	005	0	1	01	01	H5577_005_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5577	008	0	1	02	01	H5577_008_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5577	008	0	1	02	01	H5577_008_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5577	008	0	1	02	01	H5577_008_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5577	008	0	1	02	01	H5577_008_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5577	008	0	1	02	01	H5577_008_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5577	008	0	1	02	01	H5577_008_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5577	031	0	1	01	01	H5577_031_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5577	031	0	1	01	01	H5577_031_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5577	031	0	1	01	01	H5577_031_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5577	031	0	1	01	01	H5577_031_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5577	031	0	1	01	01	H5577_031_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5577	031	0	1	01	01	H5577_031_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5577	038	0	1	01	01	H5577_038_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5577	038	0	1	01	01	H5577_038_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5577	038	0	1	01	01	H5577_038_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5577	038	0	1	01	01	H5577_038_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5577	038	0	1	01	01	H5577_038_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5577	038	0	1	01	01	H5577_038_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5577	039	0	1	01	01	H5577_039_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5577	039	0	1	01	01	H5577_039_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	3						
H5577	039	0	1	01	01	H5577_039_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H5577	039	0	1	01	01	H5577_039_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H5577	039	0	1	01	01	H5577_039_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5577	040	0	1	01	01	H5577_040_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5577	040	0	1	01	01	H5577_040_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5577	040	0	1	01	01	H5577_040_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5577	040	0	1	01	01	H5577_040_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5577	040	0	1	01	01	H5577_040_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5577	040	0	1	01	01	H5577_040_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5590	004	0	1	01	01	H5590_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5590	004	0	1	01	01	H5590_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5590	004	0	1	01	01	H5590_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5590	004	0	1	01	01	H5590_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5590	004	0	1	01	01	H5590_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5590	004	0	1	01	01	H5590_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5590	005	0	1	01	01	H5590_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5590	005	0	1	01	01	H5590_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5590	005	0	1	01	01	H5590_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5590	005	0	1	01	01	H5590_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5590	005	0	1	01	01	H5590_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5590	005	0	1	01	01	H5590_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5590	007	0	1	01	01	H5590_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5590	007	0	1	01	01	H5590_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5590	007	0	1	01	01	H5590_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5590	007	0	1	01	01	H5590_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5590	007	0	1	01	01	H5590_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5590	008	0	1	01	01	H5590_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5590	008	0	1	01	01	H5590_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5590	008	0	1	01	01	H5590_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5590	008	0	1	01	01	H5590_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5590	008	0	1	01	01	H5590_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5591	001	0	1	02	01	H5591_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5591	001	0	1	02	01	H5591_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5591	001	0	1	02	01	H5591_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5591	001	0	1	02	01	H5591_001_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5591	001	0	1	02	01	H5591_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H5591	005	0	1	02	01	H5591_005_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5591	005	0	1	02	01	H5591_005_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5591	005	0	1	02	01	H5591_005_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5591	005	0	1	02	01	H5591_005_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5591	005	0	1	02	01	H5591_005_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H5591	006	1	1	02	01	H5591_006_1	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5591	006	1	1	02	01	H5591_006_1	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5591	006	1	1	02	01	H5591_006_1	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5591	006	1	1	02	01	H5591_006_1	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5591	006	1	1	02	01	H5591_006_1	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H5591	006	2	1	02	01	H5591_006_2	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5591	006	2	1	02	01	H5591_006_2	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5591	006	2	1	02	01	H5591_006_2	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5591	006	2	1	02	01	H5591_006_2	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5591	006	2	1	02	01	H5591_006_2	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H5591	006	4	1	02	01	H5591_006_4	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5591	006	4	1	02	01	H5591_006_4	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5591	006	4	1	02	01	H5591_006_4	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5591	006	4	1	02	01	H5591_006_4	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5591	006	4	1	02	01	H5591_006_4	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H5591	007	0	1	01	01	H5591_007_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5591	007	0	1	01	01	H5591_007_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5591	007	0	1	01	01	H5591_007_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5591	007	0	1	01	01	H5591_007_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5591	007	0	1	01	01	H5591_007_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H5591	009	0	1	01	01	H5591_009_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5591	009	0	1	01	01	H5591_009_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5591	009	0	1	01	01	H5591_009_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5591	009	0	1	01	01	H5591_009_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5591	009	0	1	01	01	H5591_009_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H5591	013	0	1	01	01	H5591_013_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5591	013	0	1	01	01	H5591_013_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5591	013	0	1	01	01	H5591_013_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5591	013	0	1	01	01	H5591_013_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5591	013	0	1	01	01	H5591_013_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H5593	001	0	1	01	01	H5593_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5593	001	0	1	01	01	H5593_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5593	001	0	1	01	01	H5593_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5593	001	0	1	01	01	H5593_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5593	001	0	1	01	01	H5593_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5594	001	0	1	01	01	H5594_001_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	001	0	1	01	01	H5594_001_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	001	0	1	01	01	H5594_001_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	001	0	1	01	01	H5594_001_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	002	0	1	01	01	H5594_002_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	002	0	1	01	01	H5594_002_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	002	0	1	01	01	H5594_002_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	002	0	1	01	01	H5594_002_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	016	0	1	01	01	H5594_016_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	016	0	1	01	01	H5594_016_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	016	0	1	01	01	H5594_016_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	016	0	1	01	01	H5594_016_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	017	0	1	01	01	H5594_017_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	017	0	1	01	01	H5594_017_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	017	0	1	01	01	H5594_017_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	017	0	1	01	01	H5594_017_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	019	0	1	01	01	H5594_019_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	019	0	1	01	01	H5594_019_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	019	0	1	01	01	H5594_019_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	019	0	1	01	01	H5594_019_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	022	0	1	01	01	H5594_022_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	022	0	1	01	01	H5594_022_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	022	0	1	01	01	H5594_022_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	022	0	1	01	01	H5594_022_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	026	0	1	01	01	H5594_026_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	026	0	1	01	01	H5594_026_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	026	0	1	01	01	H5594_026_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	026	0	1	01	01	H5594_026_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	028	0	1	01	01	H5594_028_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	11	3						
H5594	028	0	1	01	01	H5594_028_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	11	3						
H5594	028	0	1	01	01	H5594_028_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	3						
H5594	028	0	1	01	01	H5594_028_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H5594	028	0	1	01	01	H5594_028_0	6	Select Diabetic Drugs	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	10	1						
H5594	029	0	1	01	01	H5594_029_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	029	0	1	01	01	H5594_029_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	029	0	1	01	01	H5594_029_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	029	0	1	01	01	H5594_029_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	030	0	1	01	01	H5594_030_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	11	3						
H5594	030	0	1	01	01	H5594_030_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	11	3						
H5594	030	0	1	01	01	H5594_030_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	11	3						
H5594	030	0	1	01	01	H5594_030_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H5594	030	0	1	01	01	H5594_030_0	6	Select Diabetic Drugs	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	10	1						
H5594	031	0	1	01	01	H5594_031_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	031	0	1	01	01	H5594_031_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	031	0	1	01	01	H5594_031_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	031	0	1	01	01	H5594_031_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	032	0	1	01	01	H5594_032_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	032	0	1	01	01	H5594_032_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	032	0	1	01	01	H5594_032_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	032	0	1	01	01	H5594_032_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	034	0	1	01	01	H5594_034_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	034	0	1	01	01	H5594_034_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	034	0	1	01	01	H5594_034_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	034	0	1	01	01	H5594_034_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5594	035	0	1	01	01	H5594_035_0	6	Preferred Generic	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5594	035	0	1	01	01	H5594_035_0	6	Preferred Brand	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5594	035	0	1	01	01	H5594_035_0	6	Non-Preferred Drug	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	3						
H5594	035	0	1	01	01	H5594_035_0	6	Specialty Tier	4	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5599	001	0	1	01	01	H5599_001_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5599	001	0	1	01	01	H5599_001_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5599	001	0	1	01	01	H5599_001_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5599	001	0	1	01	01	H5599_001_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5599	001	0	1	01	01	H5599_001_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5599	002	0	1	02	01	H5599_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5599	002	0	1	02	01	H5599_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5599	002	0	1	02	01	H5599_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5599	002	0	1	02	01	H5599_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5599	002	0	1	02	01	H5599_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5599	003	0	1	01	01	H5599_003_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5599	003	0	1	01	01	H5599_003_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5599	003	0	1	01	01	H5599_003_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5599	003	0	1	01	01	H5599_003_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5599	003	0	1	01	01	H5599_003_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5599	004	0	1	01	01	H5599_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5599	004	0	1	01	01	H5599_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5599	004	0	1	01	01	H5599_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5599	004	0	1	01	01	H5599_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5599	004	0	1	01	01	H5599_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5599	006	0	1	01	01	H5599_006_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5599	006	0	1	01	01	H5599_006_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5599	006	0	1	01	01	H5599_006_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5599	006	0	1	01	01	H5599_006_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5599	006	0	1	01	01	H5599_006_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5599	007	0	1	02	01	H5599_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5599	007	0	1	02	01	H5599_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5599	007	0	1	02	01	H5599_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5599	007	0	1	02	01	H5599_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5599	007	0	1	02	01	H5599_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5599	008	0	1	01	01	H5599_008_0	5	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5599	008	0	1	01	01	H5599_008_0	5	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5599	008	0	1	01	01	H5599_008_0	5	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5599	008	0	1	01	01	H5599_008_0	5	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5599	008	0	1	01	01	H5599_008_0	5	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5599	009	0	1	01	01	H5599_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5599	009	0	1	01	01	H5599_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5599	009	0	1	01	01	H5599_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5599	009	0	1	01	01	H5599_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5599	009	0	1	01	01	H5599_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5608	002	0	1	01	01	H5608_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5608	002	0	1	01	01	H5608_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H5608	002	0	1	01	01	H5608_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5608	002	0	1	01	01	H5608_002_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5608	002	0	1	01	01	H5608_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5608	002	0	1	01	01	H5608_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H5619	001	0	1	01	01	H5619_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	001	0	1	01	01	H5619_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	001	0	1	01	01	H5619_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	001	0	1	01	01	H5619_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	001	0	1	01	01	H5619_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	003	0	1	01	01	H5619_003_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	003	0	1	01	01	H5619_003_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	003	0	1	01	01	H5619_003_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	003	0	1	01	01	H5619_003_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	003	0	1	01	01	H5619_003_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	012	0	1	01	01	H5619_012_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	012	0	1	01	01	H5619_012_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	012	0	1	01	01	H5619_012_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	012	0	1	01	01	H5619_012_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	012	0	1	01	01	H5619_012_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	013	0	1	01	01	H5619_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	013	0	1	01	01	H5619_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	013	0	1	01	01	H5619_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	013	0	1	01	01	H5619_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	013	0	1	01	01	H5619_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	015	0	1	01	01	H5619_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	015	0	1	01	01	H5619_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	015	0	1	01	01	H5619_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	015	0	1	01	01	H5619_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	015	0	1	01	01	H5619_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	016	0	1	01	01	H5619_016_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	016	0	1	01	01	H5619_016_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	016	0	1	01	01	H5619_016_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	016	0	1	01	01	H5619_016_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	016	0	1	01	01	H5619_016_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	021	0	1	01	01	H5619_021_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	021	0	1	01	01	H5619_021_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	021	0	1	01	01	H5619_021_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	021	0	1	01	01	H5619_021_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	021	0	1	01	01	H5619_021_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	026	0	1	01	01	H5619_026_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	026	0	1	01	01	H5619_026_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	026	0	1	01	01	H5619_026_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	026	0	1	01	01	H5619_026_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	026	0	1	01	01	H5619_026_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	029	0	1	01	01	H5619_029_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	029	0	1	01	01	H5619_029_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	029	0	1	01	01	H5619_029_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	029	0	1	01	01	H5619_029_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	029	0	1	01	01	H5619_029_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	032	0	1	01	01	H5619_032_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	032	0	1	01	01	H5619_032_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	032	0	1	01	01	H5619_032_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	032	0	1	01	01	H5619_032_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	032	0	1	01	01	H5619_032_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	037	0	1	01	01	H5619_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	037	0	1	01	01	H5619_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	037	0	1	01	01	H5619_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	037	0	1	01	01	H5619_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	037	0	1	01	01	H5619_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	038	0	1	01	01	H5619_038_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	038	0	1	01	01	H5619_038_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	038	0	1	01	01	H5619_038_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	038	0	1	01	01	H5619_038_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	038	0	1	01	01	H5619_038_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	039	1	1	01	01	H5619_039_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	039	1	1	01	01	H5619_039_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	039	1	1	01	01	H5619_039_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	039	1	1	01	01	H5619_039_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	039	1	1	01	01	H5619_039_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	039	2	1	01	01	H5619_039_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	039	2	1	01	01	H5619_039_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	039	2	1	01	01	H5619_039_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	039	2	1	01	01	H5619_039_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	039	2	1	01	01	H5619_039_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	041	0	1	01	01	H5619_041_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	041	0	1	01	01	H5619_041_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	041	0	1	01	01	H5619_041_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	041	0	1	01	01	H5619_041_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	041	0	1	01	01	H5619_041_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	044	0	1	01	01	H5619_044_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	044	0	1	01	01	H5619_044_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	044	0	1	01	01	H5619_044_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	044	0	1	01	01	H5619_044_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	044	0	1	01	01	H5619_044_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	045	0	1	01	01	H5619_045_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	045	0	1	01	01	H5619_045_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	045	0	1	01	01	H5619_045_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	045	0	1	01	01	H5619_045_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	045	0	1	01	01	H5619_045_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	046	0	1	01	01	H5619_046_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5619	046	0	1	01	01	H5619_046_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5619	046	0	1	01	01	H5619_046_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5619	046	0	1	01	01	H5619_046_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5619	046	0	1	01	01	H5619_046_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5619	046	0	1	01	01	H5619_046_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5619	047	0	1	01	01	H5619_047_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	047	0	1	01	01	H5619_047_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	047	0	1	01	01	H5619_047_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	047	0	1	01	01	H5619_047_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	047	0	1	01	01	H5619_047_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	049	0	1	01	01	H5619_049_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	049	0	1	01	01	H5619_049_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	049	0	1	01	01	H5619_049_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	049	0	1	01	01	H5619_049_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	049	0	1	01	01	H5619_049_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	050	0	1	01	01	H5619_050_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	050	0	1	01	01	H5619_050_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	050	0	1	01	01	H5619_050_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	050	0	1	01	01	H5619_050_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	050	0	1	01	01	H5619_050_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	051	0	1	01	01	H5619_051_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	051	0	1	01	01	H5619_051_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	051	0	1	01	01	H5619_051_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	051	0	1	01	01	H5619_051_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	051	0	1	01	01	H5619_051_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	052	0	1	01	01	H5619_052_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	052	0	1	01	01	H5619_052_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	052	0	1	01	01	H5619_052_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	052	0	1	01	01	H5619_052_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	052	0	1	01	01	H5619_052_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	053	0	1	01	01	H5619_053_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	053	0	1	01	01	H5619_053_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	053	0	1	01	01	H5619_053_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	053	0	1	01	01	H5619_053_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	053	0	1	01	01	H5619_053_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	054	0	1	01	01	H5619_054_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	054	0	1	01	01	H5619_054_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	054	0	1	01	01	H5619_054_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	054	0	1	01	01	H5619_054_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	054	0	1	01	01	H5619_054_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	055	0	1	01	01	H5619_055_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5619	055	0	1	01	01	H5619_055_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5619	055	0	1	01	01	H5619_055_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5619	055	0	1	01	01	H5619_055_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5619	055	0	1	01	01	H5619_055_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5619	055	0	1	01	01	H5619_055_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5619	056	0	1	01	01	H5619_056_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	056	0	1	01	01	H5619_056_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	056	0	1	01	01	H5619_056_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	056	0	1	01	01	H5619_056_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	056	0	1	01	01	H5619_056_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	057	0	1	01	01	H5619_057_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	057	0	1	01	01	H5619_057_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	057	0	1	01	01	H5619_057_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	057	0	1	01	01	H5619_057_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	057	0	1	01	01	H5619_057_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	059	0	1	01	01	H5619_059_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	059	0	1	01	01	H5619_059_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	059	0	1	01	01	H5619_059_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	059	0	1	01	01	H5619_059_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	059	0	1	01	01	H5619_059_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	060	0	1	01	01	H5619_060_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	060	0	1	01	01	H5619_060_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	060	0	1	01	01	H5619_060_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	060	0	1	01	01	H5619_060_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	060	0	1	01	01	H5619_060_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	061	0	1	01	01	H5619_061_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	061	0	1	01	01	H5619_061_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	061	0	1	01	01	H5619_061_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	061	0	1	01	01	H5619_061_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	061	0	1	01	01	H5619_061_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	062	0	1	01	01	H5619_062_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	062	0	1	01	01	H5619_062_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	062	0	1	01	01	H5619_062_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	062	0	1	01	01	H5619_062_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	062	0	1	01	01	H5619_062_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	063	0	1	01	01	H5619_063_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	063	0	1	01	01	H5619_063_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	063	0	1	01	01	H5619_063_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	063	0	1	01	01	H5619_063_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	063	0	1	01	01	H5619_063_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	064	0	1	01	01	H5619_064_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	064	0	1	01	01	H5619_064_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	064	0	1	01	01	H5619_064_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	064	0	1	01	01	H5619_064_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	064	0	1	01	01	H5619_064_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	065	0	1	01	01	H5619_065_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	065	0	1	01	01	H5619_065_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	065	0	1	01	01	H5619_065_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	065	0	1	01	01	H5619_065_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	065	0	1	01	01	H5619_065_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	066	0	1	01	01	H5619_066_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	066	0	1	01	01	H5619_066_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	066	0	1	01	01	H5619_066_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	066	0	1	01	01	H5619_066_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	066	0	1	01	01	H5619_066_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	069	0	1	01	01	H5619_069_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	069	0	1	01	01	H5619_069_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	069	0	1	01	01	H5619_069_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	069	0	1	01	01	H5619_069_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	069	0	1	01	01	H5619_069_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	071	0	1	01	01	H5619_071_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	071	0	1	01	01	H5619_071_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	071	0	1	01	01	H5619_071_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	071	0	1	01	01	H5619_071_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	071	0	1	01	01	H5619_071_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	073	0	1	01	01	H5619_073_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	073	0	1	01	01	H5619_073_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	073	0	1	01	01	H5619_073_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	073	0	1	01	01	H5619_073_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	073	0	1	01	01	H5619_073_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	075	0	1	01	01	H5619_075_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	075	0	1	01	01	H5619_075_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	075	0	1	01	01	H5619_075_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	075	0	1	01	01	H5619_075_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	075	0	1	01	01	H5619_075_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	076	0	1	01	01	H5619_076_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	076	0	1	01	01	H5619_076_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	076	0	1	01	01	H5619_076_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	076	0	1	01	01	H5619_076_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	076	0	1	01	01	H5619_076_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	077	0	1	01	01	H5619_077_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	077	0	1	01	01	H5619_077_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	077	0	1	01	01	H5619_077_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	077	0	1	01	01	H5619_077_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	077	0	1	01	01	H5619_077_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	078	0	1	01	01	H5619_078_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	078	0	1	01	01	H5619_078_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	078	0	1	01	01	H5619_078_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	078	0	1	01	01	H5619_078_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	078	0	1	01	01	H5619_078_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	080	0	1	01	01	H5619_080_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	080	0	1	01	01	H5619_080_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	080	0	1	01	01	H5619_080_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	080	0	1	01	01	H5619_080_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	080	0	1	01	01	H5619_080_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	082	0	1	01	01	H5619_082_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	082	0	1	01	01	H5619_082_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	082	0	1	01	01	H5619_082_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	082	0	1	01	01	H5619_082_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	082	0	1	01	01	H5619_082_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	083	0	1	01	01	H5619_083_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	083	0	1	01	01	H5619_083_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	083	0	1	01	01	H5619_083_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	083	0	1	01	01	H5619_083_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	083	0	1	01	01	H5619_083_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	086	0	1	01	01	H5619_086_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	086	0	1	01	01	H5619_086_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	086	0	1	01	01	H5619_086_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	086	0	1	01	01	H5619_086_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	086	0	1	01	01	H5619_086_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	087	0	1	01	01	H5619_087_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5619	087	0	1	01	01	H5619_087_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5619	087	0	1	01	01	H5619_087_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5619	087	0	1	01	01	H5619_087_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5619	087	0	1	01	01	H5619_087_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5619	087	0	1	01	01	H5619_087_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5619	088	0	1	01	01	H5619_088_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	088	0	1	01	01	H5619_088_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	088	0	1	01	01	H5619_088_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	088	0	1	01	01	H5619_088_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	088	0	1	01	01	H5619_088_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	089	0	1	01	01	H5619_089_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	089	0	1	01	01	H5619_089_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	089	0	1	01	01	H5619_089_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	089	0	1	01	01	H5619_089_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	089	0	1	01	01	H5619_089_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	090	0	1	02	01	H5619_090_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	090	0	1	02	01	H5619_090_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	090	0	1	02	01	H5619_090_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	090	0	1	02	01	H5619_090_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	090	0	1	02	01	H5619_090_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	091	0	1	02	01	H5619_091_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	091	0	1	02	01	H5619_091_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	091	0	1	02	01	H5619_091_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	091	0	1	02	01	H5619_091_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	091	0	1	02	01	H5619_091_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	093	0	1	01	01	H5619_093_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	093	0	1	01	01	H5619_093_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	093	0	1	01	01	H5619_093_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	093	0	1	01	01	H5619_093_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	093	0	1	01	01	H5619_093_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	094	0	1	01	01	H5619_094_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	094	0	1	01	01	H5619_094_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	094	0	1	01	01	H5619_094_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	094	0	1	01	01	H5619_094_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	094	0	1	01	01	H5619_094_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	095	0	1	02	01	H5619_095_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	095	0	1	02	01	H5619_095_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	095	0	1	02	01	H5619_095_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	095	0	1	02	01	H5619_095_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	095	0	1	02	01	H5619_095_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	097	0	1	01	01	H5619_097_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	097	0	1	01	01	H5619_097_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	097	0	1	01	01	H5619_097_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	097	0	1	01	01	H5619_097_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	097	0	1	01	01	H5619_097_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	099	0	1	01	01	H5619_099_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	099	0	1	01	01	H5619_099_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	099	0	1	01	01	H5619_099_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	099	0	1	01	01	H5619_099_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	099	0	1	01	01	H5619_099_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	100	0	1	01	01	H5619_100_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	100	0	1	01	01	H5619_100_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	100	0	1	01	01	H5619_100_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	100	0	1	01	01	H5619_100_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	100	0	1	01	01	H5619_100_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	101	0	1	01	01	H5619_101_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	101	0	1	01	01	H5619_101_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	101	0	1	01	01	H5619_101_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	101	0	1	01	01	H5619_101_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	101	0	1	01	01	H5619_101_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	109	0	1	01	01	H5619_109_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	109	0	1	01	01	H5619_109_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	109	0	1	01	01	H5619_109_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	109	0	1	01	01	H5619_109_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	109	0	1	01	01	H5619_109_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	111	0	1	01	01	H5619_111_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	111	0	1	01	01	H5619_111_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H5619	111	0	1	01	01	H5619_111_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	111	0	1	01	01	H5619_111_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	111	0	1	01	01	H5619_111_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	112	0	1	01	01	H5619_112_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	112	0	1	01	01	H5619_112_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	112	0	1	01	01	H5619_112_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	112	0	1	01	01	H5619_112_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	112	0	1	01	01	H5619_112_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	113	0	1	01	01	H5619_113_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	113	0	1	01	01	H5619_113_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	113	0	1	01	01	H5619_113_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	113	0	1	01	01	H5619_113_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	113	0	1	01	01	H5619_113_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	114	0	1	01	01	H5619_114_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	114	0	1	01	01	H5619_114_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	114	0	1	01	01	H5619_114_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	114	0	1	01	01	H5619_114_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	114	0	1	01	01	H5619_114_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	115	0	1	01	01	H5619_115_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	115	0	1	01	01	H5619_115_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	115	0	1	01	01	H5619_115_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	115	0	1	01	01	H5619_115_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	115	0	1	01	01	H5619_115_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	116	0	1	01	01	H5619_116_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	116	0	1	01	01	H5619_116_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	116	0	1	01	01	H5619_116_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	116	0	1	01	01	H5619_116_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	116	0	1	01	01	H5619_116_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	118	0	1	01	01	H5619_118_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	118	0	1	01	01	H5619_118_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	118	0	1	01	01	H5619_118_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	118	0	1	01	01	H5619_118_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	118	0	1	01	01	H5619_118_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	119	0	1	01	01	H5619_119_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	119	0	1	01	01	H5619_119_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	119	0	1	01	01	H5619_119_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	119	0	1	01	01	H5619_119_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	119	0	1	01	01	H5619_119_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	122	0	1	01	01	H5619_122_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	122	0	1	01	01	H5619_122_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	122	0	1	01	01	H5619_122_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	122	0	1	01	01	H5619_122_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	122	0	1	01	01	H5619_122_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	123	0	1	01	01	H5619_123_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	123	0	1	01	01	H5619_123_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	123	0	1	01	01	H5619_123_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	123	0	1	01	01	H5619_123_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	123	0	1	01	01	H5619_123_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	124	0	1	01	01	H5619_124_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	124	0	1	01	01	H5619_124_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	124	0	1	01	01	H5619_124_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	124	0	1	01	01	H5619_124_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	124	0	1	01	01	H5619_124_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	126	0	1	01	01	H5619_126_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	126	0	1	01	01	H5619_126_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	126	0	1	01	01	H5619_126_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	126	0	1	01	01	H5619_126_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	126	0	1	01	01	H5619_126_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	128	0	1	01	01	H5619_128_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	128	0	1	01	01	H5619_128_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	128	0	1	01	01	H5619_128_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	128	0	1	01	01	H5619_128_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	128	0	1	01	01	H5619_128_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	129	0	1	01	01	H5619_129_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	129	0	1	01	01	H5619_129_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	129	0	1	01	01	H5619_129_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	129	0	1	01	01	H5619_129_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	129	0	1	01	01	H5619_129_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	130	1	1	01	01	H5619_130_1	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	130	1	1	01	01	H5619_130_1	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	130	1	1	01	01	H5619_130_1	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	130	1	1	01	01	H5619_130_1	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	130	1	1	01	01	H5619_130_1	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	130	2	1	01	01	H5619_130_2	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	130	2	1	01	01	H5619_130_2	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	130	2	1	01	01	H5619_130_2	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	130	2	1	01	01	H5619_130_2	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	130	2	1	01	01	H5619_130_2	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	131	0	1	01	01	H5619_131_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	131	0	1	01	01	H5619_131_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	131	0	1	01	01	H5619_131_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	131	0	1	01	01	H5619_131_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	131	0	1	01	01	H5619_131_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	132	1	1	01	01	H5619_132_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	132	1	1	01	01	H5619_132_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	132	1	1	01	01	H5619_132_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	132	1	1	01	01	H5619_132_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	132	1	1	01	01	H5619_132_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	132	2	1	01	01	H5619_132_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	132	2	1	01	01	H5619_132_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	132	2	1	01	01	H5619_132_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	132	2	1	01	01	H5619_132_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	132	2	1	01	01	H5619_132_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	133	0	1	01	01	H5619_133_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	133	0	1	01	01	H5619_133_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	133	0	1	01	01	H5619_133_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	133	0	1	01	01	H5619_133_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	133	0	1	01	01	H5619_133_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	134	0	1	01	01	H5619_134_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	134	0	1	01	01	H5619_134_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	134	0	1	01	01	H5619_134_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	134	0	1	01	01	H5619_134_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	134	0	1	01	01	H5619_134_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	135	0	1	01	01	H5619_135_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	135	0	1	01	01	H5619_135_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	135	0	1	01	01	H5619_135_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	135	0	1	01	01	H5619_135_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	135	0	1	01	01	H5619_135_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	136	1	1	01	01	H5619_136_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	136	1	1	01	01	H5619_136_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	136	1	1	01	01	H5619_136_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	136	1	1	01	01	H5619_136_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	136	1	1	01	01	H5619_136_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	136	2	1	01	01	H5619_136_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	136	2	1	01	01	H5619_136_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	136	2	1	01	01	H5619_136_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	136	2	1	01	01	H5619_136_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	136	2	1	01	01	H5619_136_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	136	3	1	01	01	H5619_136_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	136	3	1	01	01	H5619_136_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	136	3	1	01	01	H5619_136_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	136	3	1	01	01	H5619_136_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	136	3	1	01	01	H5619_136_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	136	4	1	01	01	H5619_136_4	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5619	136	4	1	01	01	H5619_136_4	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	136	4	1	01	01	H5619_136_4	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	136	4	1	01	01	H5619_136_4	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	136	4	1	01	01	H5619_136_4	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5619	137	0	1	01	01	H5619_137_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5619	137	0	1	01	01	H5619_137_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5619	137	0	1	01	01	H5619_137_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5619	137	0	1	01	01	H5619_137_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5619	137	0	1	01	01	H5619_137_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5628	001	0	1	01	01	H5628_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5628	001	0	1	01	01	H5628_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5628	001	0	1	01	01	H5628_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5628	001	0	1	01	01	H5628_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5628	001	0	1	01	01	H5628_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5628	007	0	1	01	01	H5628_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5628	007	0	1	01	01	H5628_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5628	007	0	1	01	01	H5628_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5628	007	0	1	01	01	H5628_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5628	007	0	1	01	01	H5628_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5628	007	0	1	01	01	H5628_007_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5628	008	0	1	01	01	H5628_008_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5628	008	0	1	01	01	H5628_008_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5628	008	0	1	01	01	H5628_008_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5628	008	0	1	01	01	H5628_008_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5628	008	0	1	01	01	H5628_008_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5628	009	0	1	01	01	H5628_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5628	009	0	1	01	01	H5628_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5628	009	0	1	01	01	H5628_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5628	009	0	1	01	01	H5628_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5628	009	0	1	01	01	H5628_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5628	009	0	1	01	01	H5628_009_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5628	010	0	1	01	01	H5628_010_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5628	010	0	1	01	01	H5628_010_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5628	010	0	1	01	01	H5628_010_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5628	010	0	1	01	01	H5628_010_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5628	010	0	1	01	01	H5628_010_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5628	010	0	1	01	01	H5628_010_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H5644	002	0	1	01	01	H5644_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H5644	002	0	1	01	01	H5644_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H5644	002	0	1	01	01	H5644_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H5644	002	0	1	01	01	H5644_002_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H5644	002	0	1	01	01	H5644_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H5649	001	0	1	01	01	H5649_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H5649	001	0	1	01	01	H5649_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5649	001	0	1	01	01	H5649_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5649	001	0	1	01	01	H5649_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H5649	001	0	1	01	01	H5649_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5649	001	0	1	01	01	H5649_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H5649	002	0	1	01	01	H5649_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H5649	002	0	1	01	01	H5649_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5649	002	0	1	01	01	H5649_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5649	002	0	1	01	01	H5649_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H5649	002	0	1	01	01	H5649_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5649	002	0	1	01	01	H5649_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H5649	004	0	1	01	01	H5649_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H5649	004	0	1	01	01	H5649_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5649	004	0	1	01	01	H5649_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5649	004	0	1	01	01	H5649_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H5649	004	0	1	01	01	H5649_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5649	004	0	1	01	01	H5649_004_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H5649	006	0	1	01	01	H5649_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H5649	006	0	1	01	01	H5649_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5649	006	0	1	01	01	H5649_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5649	006	0	1	01	01	H5649_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H5649	006	0	1	01	01	H5649_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5649	006	0	1	01	01	H5649_006_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H5649	008	0	1	01	01	H5649_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H5649	008	0	1	01	01	H5649_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5649	008	0	1	01	01	H5649_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5649	008	0	1	01	01	H5649_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H5649	008	0	1	01	01	H5649_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5649	008	0	1	01	01	H5649_008_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H5649	009	0	1	01	01	H5649_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	3						
H5649	009	0	1	01	01	H5649_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5649	009	0	1	01	01	H5649_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5649	009	0	1	01	01	H5649_009_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H5649	009	0	1	01	01	H5649_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5649	009	0	1	01	01	H5649_009_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H5652	001	0	1	02	01	H5652_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5652	001	0	1	02	01	H5652_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5652	001	0	1	02	01	H5652_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5652	001	0	1	02	01	H5652_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5652	001	0	1	02	01	H5652_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5652	003	0	1	02	01	H5652_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5652	003	0	1	02	01	H5652_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5652	003	0	1	02	01	H5652_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5652	003	0	1	02	01	H5652_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5652	003	0	1	02	01	H5652_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5652	004	0	1	02	01	H5652_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5652	004	0	1	02	01	H5652_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5652	004	0	1	02	01	H5652_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5652	004	0	1	02	01	H5652_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5652	004	0	1	02	01	H5652_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5652	006	0	1	02	01	H5652_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5652	006	0	1	02	01	H5652_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5652	006	0	1	02	01	H5652_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5652	006	0	1	02	01	H5652_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5652	006	0	1	02	01	H5652_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5652	008	0	1	02	01	H5652_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5652	008	0	1	02	01	H5652_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H5652	008	0	1	02	01	H5652_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5652	008	0	1	02	01	H5652_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5652	008	0	1	02	01	H5652_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5656	001	0	1	01	01	H5656_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5656	001	0	1	01	01	H5656_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5656	001	0	1	01	01	H5656_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5656	001	0	1	01	01	H5656_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5656	001	0	1	01	01	H5656_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5746	016	0	1	01	01	H5746_016_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5746	016	0	1	01	01	H5746_016_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5746	016	0	1	01	01	H5746_016_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5746	016	0	1	01	01	H5746_016_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5746	016	0	1	01	01	H5746_016_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5746	016	0	1	01	01	H5746_016_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5746	018	0	1	01	01	H5746_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5746	018	0	1	01	01	H5746_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5746	018	0	1	01	01	H5746_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5746	018	0	1	01	01	H5746_018_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5746	018	0	1	01	01	H5746_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5746	018	0	1	01	01	H5746_018_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5774	005	0	1	01	01	H5774_005_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	005	0	1	01	01	H5774_005_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5774	005	0	1	01	01	H5774_005_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	005	0	1	01	01	H5774_005_0	13	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	3						
H5774	005	0	1	01	01	H5774_005_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	005	0	1	01	01	H5774_005_0	13	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	022	0	1	01	01	H5774_022_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	022	0	1	01	01	H5774_022_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5774	022	0	1	01	01	H5774_022_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	022	0	1	01	01	H5774_022_0	12	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	3						
H5774	022	0	1	01	01	H5774_022_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	022	0	1	01	01	H5774_022_0	12	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	024	0	1	01	01	H5774_024_0	11	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	024	0	1	01	01	H5774_024_0	11	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H5774	024	0	1	01	01	H5774_024_0	11	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	024	0	1	01	01	H5774_024_0	11	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5774	024	0	1	01	01	H5774_024_0	11	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	024	0	1	01	01	H5774_024_0	11	Select Care Drugs	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	025	0	1	01	01	H5774_025_0	12	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	025	0	1	01	01	H5774_025_0	12	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H5774	025	0	1	01	01	H5774_025_0	12	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	025	0	1	01	01	H5774_025_0	12	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5774	025	0	1	01	01	H5774_025_0	12	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	025	0	1	01	01	H5774_025_0	12	Select Care Drugs	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	026	0	1	01	01	H5774_026_0	12	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	026	0	1	01	01	H5774_026_0	12	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H5774	026	0	1	01	01	H5774_026_0	12	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	026	0	1	01	01	H5774_026_0	12	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5774	026	0	1	01	01	H5774_026_0	12	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	026	0	1	01	01	H5774_026_0	12	Select Care Drugs	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	027	0	1	02	01	H5774_027_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	027	0	1	02	01	H5774_027_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5774	027	0	1	02	01	H5774_027_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	027	0	1	02	01	H5774_027_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	3						
H5774	027	0	1	02	01	H5774_027_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	027	0	1	02	01	H5774_027_0	11	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	028	0	1	01	01	H5774_028_0	11	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	028	0	1	01	01	H5774_028_0	11	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H5774	028	0	1	01	01	H5774_028_0	11	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	028	0	1	01	01	H5774_028_0	11	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5774	028	0	1	01	01	H5774_028_0	11	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	028	0	1	01	01	H5774_028_0	11	Select Care Drugs	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	031	0	1	02	01	H5774_031_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	031	0	1	02	01	H5774_031_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5774	031	0	1	02	01	H5774_031_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	031	0	1	02	01	H5774_031_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	3						
H5774	031	0	1	02	01	H5774_031_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	031	0	1	02	01	H5774_031_0	11	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	032	0	1	01	01	H5774_032_0	11	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	032	0	1	01	01	H5774_032_0	11	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H5774	032	0	1	01	01	H5774_032_0	11	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	032	0	1	01	01	H5774_032_0	11	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5774	032	0	1	01	01	H5774_032_0	11	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	032	0	1	01	01	H5774_032_0	11	Select Care Drugs	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	033	0	1	01	01	H5774_033_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	033	0	1	01	01	H5774_033_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	3						
H5774	033	0	1	01	01	H5774_033_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	033	0	1	01	01	H5774_033_0	11	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	3						
H5774	033	0	1	01	01	H5774_033_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	033	0	1	01	01	H5774_033_0	11	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5774	035	0	1	01	01	H5774_035_0	11	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5774	035	0	1	01	01	H5774_035_0	11	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H5774	035	0	1	01	01	H5774_035_0	11	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5774	035	0	1	01	01	H5774_035_0	11	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5774	035	0	1	01	01	H5774_035_0	11	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5774	035	0	1	01	01	H5774_035_0	11	Select Care Drugs	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5779	002	0	1	01	01	H5779_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5779	002	0	1	01	01	H5779_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5779	002	0	1	01	01	H5779_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5779	002	0	1	01	01	H5779_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5779	002	0	1	01	01	H5779_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5779	005	0	1	01	01	H5779_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5779	005	0	1	01	01	H5779_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5779	005	0	1	01	01	H5779_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5779	005	0	1	01	01	H5779_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5779	005	0	1	01	01	H5779_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5779	006	0	1	01	01	H5779_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5779	006	0	1	01	01	H5779_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5779	006	0	1	01	01	H5779_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5779	006	0	1	01	01	H5779_006_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5779	006	0	1	01	01	H5779_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5779	007	0	1	01	01	H5779_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5779	007	0	1	01	01	H5779_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5779	007	0	1	01	01	H5779_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5779	007	0	1	01	01	H5779_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5779	007	0	1	01	01	H5779_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5793	001	0	1	01	01	H5793_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5793	001	0	1	01	01	H5793_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5793	001	0	1	01	01	H5793_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5793	001	0	1	01	01	H5793_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5793	001	0	1	01	01	H5793_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5793	010	0	1	01	01	H5793_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5793	010	0	1	01	01	H5793_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5793	010	0	1	01	01	H5793_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5793	010	0	1	01	01	H5793_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5793	010	0	1	01	01	H5793_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5793	012	0	1	01	01	H5793_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5793	012	0	1	01	01	H5793_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5793	012	0	1	01	01	H5793_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5793	012	0	1	01	01	H5793_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5793	012	0	1	01	01	H5793_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5793	014	0	1	01	01	H5793_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5793	014	0	1	01	01	H5793_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5793	014	0	1	01	01	H5793_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5793	014	0	1	01	01	H5793_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5793	014	0	1	01	01	H5793_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5793	015	0	1	01	01	H5793_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5793	015	0	1	01	01	H5793_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5793	015	0	1	01	01	H5793_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5793	015	0	1	01	01	H5793_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5793	015	0	1	01	01	H5793_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5793	016	0	1	01	01	H5793_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5793	016	0	1	01	01	H5793_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5793	016	0	1	01	01	H5793_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5793	016	0	1	01	01	H5793_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5793	016	0	1	01	01	H5793_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5793	017	0	1	02	01	H5793_017_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5793	017	0	1	02	01	H5793_017_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5793	017	0	1	02	01	H5793_017_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5793	017	0	1	02	01	H5793_017_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5793	017	0	1	02	01	H5793_017_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5793	018	0	1	01	01	H5793_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5793	018	0	1	01	01	H5793_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5793	018	0	1	01	01	H5793_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5793	018	0	1	01	01	H5793_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5793	018	0	1	01	01	H5793_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5810	001	0	1	01	01	H5810_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5810	001	0	1	01	01	H5810_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5810	001	0	1	01	01	H5810_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5810	001	0	1	01	01	H5810_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5810	001	0	1	01	01	H5810_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5810	013	0	1	01	01	H5810_013_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5810	013	0	1	01	01	H5810_013_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5810	013	0	1	01	01	H5810_013_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5810	013	0	1	01	01	H5810_013_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5810	013	0	1	01	01	H5810_013_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5823	006	0	1	01	01	H5823_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5823	006	0	1	01	01	H5823_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5823	006	0	1	01	01	H5823_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5823	006	0	1	01	01	H5823_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5823	006	0	1	01	01	H5823_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5826	008	0	1	01	01	H5826_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5826	008	0	1	01	01	H5826_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5826	008	0	1	01	01	H5826_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5826	008	0	1	01	01	H5826_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5826	008	0	1	01	01	H5826_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5826	009	0	1	01	01	H5826_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5826	009	0	1	01	01	H5826_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5826	009	0	1	01	01	H5826_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5826	009	0	1	01	01	H5826_009_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5826	009	0	1	01	01	H5826_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5826	010	0	1	01	01	H5826_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5826	010	0	1	01	01	H5826_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5826	010	0	1	01	01	H5826_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5826	010	0	1	01	01	H5826_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5826	010	0	1	01	01	H5826_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5826	016	0	1	01	01	H5826_016_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5826	016	0	1	01	01	H5826_016_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5826	016	0	1	01	01	H5826_016_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5826	016	0	1	01	01	H5826_016_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5826	016	0	1	01	01	H5826_016_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5828	001	0	1	01	01	H5828_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5828	001	0	1	01	01	H5828_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5828	001	0	1	01	01	H5828_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5828	001	0	1	01	01	H5828_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5828	001	0	1	01	01	H5828_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5828	001	0	1	01	01	H5828_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5828	002	0	1	01	01	H5828_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5828	002	0	1	01	01	H5828_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5828	002	0	1	01	01	H5828_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5828	002	0	1	01	01	H5828_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5828	002	0	1	01	01	H5828_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5828	002	0	1	01	01	H5828_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5828	005	0	1	02	01	H5828_005_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5828	005	0	1	02	01	H5828_005_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5828	005	0	1	02	01	H5828_005_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5828	005	0	1	02	01	H5828_005_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5828	005	0	1	02	01	H5828_005_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5828	005	0	1	02	01	H5828_005_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5828	006	0	1	02	01	H5828_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5828	006	0	1	02	01	H5828_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5828	006	0	1	02	01	H5828_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5828	006	0	1	02	01	H5828_006_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5828	006	0	1	02	01	H5828_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5828	006	0	1	02	01	H5828_006_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5828	007	0	1	01	01	H5828_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5828	007	0	1	01	01	H5828_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5828	007	0	1	01	01	H5828_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5828	007	0	1	01	01	H5828_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5828	007	0	1	01	01	H5828_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5828	007	0	1	01	01	H5828_007_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5828	008	0	1	01	01	H5828_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5828	008	0	1	01	01	H5828_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5828	008	0	1	01	01	H5828_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5828	008	0	1	01	01	H5828_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5828	008	0	1	01	01	H5828_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5828	008	0	1	01	01	H5828_008_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5841	001	0	1	04	01	H5841_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5841	001	0	1	04	01	H5841_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5841	001	0	1	04	01	H5841_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5841	001	0	1	04	01	H5841_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5841	001	0	1	04	01	H5841_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5841	001	0	1	04	01	H5841_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H5841	002	0	1	04	01	H5841_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5841	002	0	1	04	01	H5841_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5841	002	0	1	04	01	H5841_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5841	002	0	1	04	01	H5841_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5841	002	0	1	04	01	H5841_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5841	002	0	1	04	01	H5841_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H5841	003	0	1	04	01	H5841_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5841	003	0	1	04	01	H5841_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5841	003	0	1	04	01	H5841_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5841	003	0	1	04	01	H5841_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5841	003	0	1	04	01	H5841_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5841	003	0	1	04	01	H5841_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H5841	004	0	1	04	01	H5841_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5841	004	0	1	04	01	H5841_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5841	004	0	1	04	01	H5841_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5841	004	0	1	04	01	H5841_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5841	004	0	1	04	01	H5841_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5841	004	0	1	04	01	H5841_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H5841	005	0	1	04	01	H5841_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5841	005	0	1	04	01	H5841_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5841	005	0	1	04	01	H5841_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5841	005	0	1	04	01	H5841_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5841	005	0	1	04	01	H5841_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5841	005	0	1	04	01	H5841_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H5841	010	0	1	04	01	H5841_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H5841	010	0	1	04	01	H5841_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H5841	010	0	1	04	01	H5841_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5841	010	0	1	04	01	H5841_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5841	010	0	1	04	01	H5841_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5841	010	0	1	04	01	H5841_010_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H5843	001	0	1	01	01	H5843_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5843	001	0	1	01	01	H5843_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H5843	001	0	1	01	01	H5843_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5843	001	0	1	01	01	H5843_001_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5843	001	0	1	01	01	H5843_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5843	001	0	1	01	01	H5843_001_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5843	002	0	1	01	01	H5843_002_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5843	002	0	1	01	01	H5843_002_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H5843	002	0	1	01	01	H5843_002_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5843	002	0	1	01	01	H5843_002_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5843	002	0	1	01	01	H5843_002_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H5843	002	0	1	01	01	H5843_002_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H5852	001	0	1	01	01	H5852_001_0	4	Generic	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H5852	001	0	1	01	01	H5852_001_0	4	Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H5852	001	0	1	01	01	H5852_001_0	4	Non-Preferred Brand	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H5852	001	0	1	01	01	H5852_001_0	4	Specialty Tier	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H5852	001	0	1	01	01	H5852_001_0	4	Select Care Drugs	4	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	01	1						
H5854	007	0	1	01	01	H5854_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5854	007	0	1	01	01	H5854_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5854	007	0	1	01	01	H5854_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5854	007	0	1	01	01	H5854_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5854	007	0	1	01	01	H5854_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5854	007	0	1	01	01	H5854_007_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5854	008	0	1	01	01	H5854_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5854	008	0	1	01	01	H5854_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5854	008	0	1	01	01	H5854_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5854	008	0	1	01	01	H5854_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5854	008	0	1	01	01	H5854_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5854	008	0	1	01	01	H5854_008_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5854	009	0	1	01	01	H5854_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5854	009	0	1	01	01	H5854_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5854	009	0	1	01	01	H5854_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5854	009	0	1	01	01	H5854_009_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5854	009	0	1	01	01	H5854_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5854	009	0	1	01	01	H5854_009_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5854	010	0	1	01	01	H5854_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5854	010	0	1	01	01	H5854_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5854	010	0	1	01	01	H5854_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5854	010	0	1	01	01	H5854_010_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5854	010	0	1	01	01	H5854_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5854	010	0	1	01	01	H5854_010_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5854	011	0	1	01	01	H5854_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5854	011	0	1	01	01	H5854_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5854	011	0	1	01	01	H5854_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5854	011	0	1	01	01	H5854_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5854	011	0	1	01	01	H5854_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5854	011	0	1	01	01	H5854_011_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5854	012	0	1	02	01	H5854_012_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5854	012	0	1	02	01	H5854_012_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5854	012	0	1	02	01	H5854_012_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5854	012	0	1	02	01	H5854_012_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5854	012	0	1	02	01	H5854_012_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5854	012	0	1	02	01	H5854_012_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5854	013	0	1	01	01	H5854_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5854	013	0	1	01	01	H5854_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5854	013	0	1	01	01	H5854_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5854	013	0	1	01	01	H5854_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5854	013	0	1	01	01	H5854_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5854	013	0	1	01	01	H5854_013_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5854	014	0	1	01	01	H5854_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H5854	014	0	1	01	01	H5854_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H5854	014	0	1	01	01	H5854_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H5854	014	0	1	01	01	H5854_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H5854	014	0	1	01	01	H5854_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H5854	014	0	1	01	01	H5854_014_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H5854	015	0	1	01	01	H5854_015_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5854	015	0	1	01	01	H5854_015_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5854	015	0	1	01	01	H5854_015_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5854	015	0	1	01	01	H5854_015_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5854	015	0	1	01	01	H5854_015_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5854	015	0	1	01	01	H5854_015_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5859	001	0	1	02	01	H5859_001_0	8	Generic	4	Generic, Brand	1	2	01	1						
H5859	001	0	1	02	01	H5859_001_0	8	Brand	4	Generic, Brand	2	2	10	1						
H5883	002	1	1	02	01	H5883_002_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	002	1	1	02	01	H5883_002_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	002	1	1	02	01	H5883_002_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	002	1	1	02	01	H5883_002_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	002	1	1	02	01	H5883_002_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	002	1	1	02	01	H5883_002_1	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	002	2	1	02	01	H5883_002_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	002	2	1	02	01	H5883_002_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	002	2	1	02	01	H5883_002_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	002	2	1	02	01	H5883_002_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	002	2	1	02	01	H5883_002_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	002	2	1	02	01	H5883_002_2	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	002	3	1	02	01	H5883_002_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	002	3	1	02	01	H5883_002_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	002	3	1	02	01	H5883_002_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	002	3	1	02	01	H5883_002_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	002	3	1	02	01	H5883_002_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	002	3	1	02	01	H5883_002_3	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	002	4	1	02	01	H5883_002_4	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	002	4	1	02	01	H5883_002_4	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	002	4	1	02	01	H5883_002_4	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	002	4	1	02	01	H5883_002_4	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	002	4	1	02	01	H5883_002_4	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	002	4	1	02	01	H5883_002_4	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	002	7	1	02	01	H5883_002_7	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	002	7	1	02	01	H5883_002_7	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	002	7	1	02	01	H5883_002_7	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	002	7	1	02	01	H5883_002_7	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	002	7	1	02	01	H5883_002_7	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	002	7	1	02	01	H5883_002_7	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	003	1	1	02	01	H5883_003_1	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	003	1	1	02	01	H5883_003_1	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	003	1	1	02	01	H5883_003_1	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	003	1	1	02	01	H5883_003_1	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	003	1	1	02	01	H5883_003_1	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	003	1	1	02	01	H5883_003_1	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	003	2	1	02	01	H5883_003_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	003	2	1	02	01	H5883_003_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	003	2	1	02	01	H5883_003_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	003	2	1	02	01	H5883_003_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	003	2	1	02	01	H5883_003_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	003	2	1	02	01	H5883_003_2	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	003	3	1	02	01	H5883_003_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	003	3	1	02	01	H5883_003_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	003	3	1	02	01	H5883_003_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	003	3	1	02	01	H5883_003_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	003	3	1	02	01	H5883_003_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	003	3	1	02	01	H5883_003_3	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	003	4	1	02	01	H5883_003_4	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	003	4	1	02	01	H5883_003_4	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	003	4	1	02	01	H5883_003_4	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	003	4	1	02	01	H5883_003_4	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	003	4	1	02	01	H5883_003_4	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	003	4	1	02	01	H5883_003_4	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	003	5	1	02	01	H5883_003_5	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	003	5	1	02	01	H5883_003_5	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	003	5	1	02	01	H5883_003_5	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	003	5	1	02	01	H5883_003_5	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	003	5	1	02	01	H5883_003_5	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	003	5	1	02	01	H5883_003_5	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	007	0	1	01	01	H5883_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	007	0	1	01	01	H5883_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	007	0	1	01	01	H5883_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	007	0	1	01	01	H5883_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	007	0	1	01	01	H5883_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	007	0	1	01	01	H5883_007_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	012	1	1	02	01	H5883_012_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5883	012	1	1	02	01	H5883_012_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5883	012	1	1	02	01	H5883_012_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5883	012	1	1	02	01	H5883_012_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5883	012	1	1	02	01	H5883_012_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5883	012	2	1	02	01	H5883_012_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5883	012	2	1	02	01	H5883_012_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5883	012	2	1	02	01	H5883_012_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5883	012	2	1	02	01	H5883_012_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5883	012	2	1	02	01	H5883_012_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5883	014	1	1	02	01	H5883_014_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	014	1	1	02	01	H5883_014_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	014	1	1	02	01	H5883_014_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	014	1	1	02	01	H5883_014_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	014	1	1	02	01	H5883_014_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	014	1	1	02	01	H5883_014_1	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	014	2	1	02	01	H5883_014_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	014	2	1	02	01	H5883_014_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	014	2	1	02	01	H5883_014_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	014	2	1	02	01	H5883_014_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	014	2	1	02	01	H5883_014_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	014	2	1	02	01	H5883_014_2	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	014	3	1	02	01	H5883_014_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	014	3	1	02	01	H5883_014_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	014	3	1	02	01	H5883_014_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	014	3	1	02	01	H5883_014_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	014	3	1	02	01	H5883_014_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	014	3	1	02	01	H5883_014_3	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	014	4	1	02	01	H5883_014_4	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	014	4	1	02	01	H5883_014_4	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	014	4	1	02	01	H5883_014_4	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	014	4	1	02	01	H5883_014_4	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	014	4	1	02	01	H5883_014_4	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	014	4	1	02	01	H5883_014_4	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5883	014	5	1	02	01	H5883_014_5	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5883	014	5	1	02	01	H5883_014_5	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5883	014	5	1	02	01	H5883_014_5	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5883	014	5	1	02	01	H5883_014_5	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5883	014	5	1	02	01	H5883_014_5	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5883	014	5	1	02	01	H5883_014_5	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5926	001	0	1	01	01	H5926_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5926	001	0	1	01	01	H5926_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5926	001	0	1	01	01	H5926_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5926	001	0	1	01	01	H5926_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5926	001	0	1	01	01	H5926_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5926	004	0	1	01	01	H5926_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5926	004	0	1	01	01	H5926_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5926	004	0	1	01	01	H5926_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5926	004	0	1	01	01	H5926_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5926	004	0	1	01	01	H5926_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	004	0	1	01	01	H5928_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	004	0	1	01	01	H5928_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	004	0	1	01	01	H5928_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	004	0	1	01	01	H5928_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	004	0	1	01	01	H5928_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	005	0	1	01	01	H5928_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	005	0	1	01	01	H5928_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	005	0	1	01	01	H5928_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	005	0	1	01	01	H5928_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	005	0	1	01	01	H5928_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	010	0	1	01	01	H5928_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	010	0	1	01	01	H5928_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	010	0	1	01	01	H5928_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	010	0	1	01	01	H5928_010_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	010	0	1	01	01	H5928_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	016	0	1	01	01	H5928_016_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	016	0	1	01	01	H5928_016_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	016	0	1	01	01	H5928_016_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	016	0	1	01	01	H5928_016_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	016	0	1	01	01	H5928_016_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	037	0	1	01	01	H5928_037_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	037	0	1	01	01	H5928_037_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	037	0	1	01	01	H5928_037_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	037	0	1	01	01	H5928_037_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	037	0	1	01	01	H5928_037_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	044	0	1	01	01	H5928_044_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	044	0	1	01	01	H5928_044_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	044	0	1	01	01	H5928_044_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	044	0	1	01	01	H5928_044_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	044	0	1	01	01	H5928_044_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	050	0	1	01	01	H5928_050_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	050	0	1	01	01	H5928_050_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	050	0	1	01	01	H5928_050_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	050	0	1	01	01	H5928_050_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	050	0	1	01	01	H5928_050_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	051	0	1	01	01	H5928_051_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	051	0	1	01	01	H5928_051_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	051	0	1	01	01	H5928_051_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	051	0	1	01	01	H5928_051_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	051	0	1	01	01	H5928_051_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	052	0	1	01	01	H5928_052_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	052	0	1	01	01	H5928_052_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	052	0	1	01	01	H5928_052_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	052	0	1	01	01	H5928_052_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	052	0	1	01	01	H5928_052_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	053	0	1	01	01	H5928_053_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	053	0	1	01	01	H5928_053_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	053	0	1	01	01	H5928_053_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	053	0	1	01	01	H5928_053_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	053	0	1	01	01	H5928_053_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5928	054	0	1	01	01	H5928_054_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5928	054	0	1	01	01	H5928_054_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5928	054	0	1	01	01	H5928_054_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5928	054	0	1	01	01	H5928_054_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5928	054	0	1	01	01	H5928_054_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5932	001	0	1	01	01	H5932_001_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5932	001	0	1	01	01	H5932_001_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5932	001	0	1	01	01	H5932_001_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5932	001	0	1	01	01	H5932_001_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5932	001	0	1	01	01	H5932_001_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5932	009	0	1	01	01	H5932_009_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5932	009	0	1	01	01	H5932_009_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5932	009	0	1	01	01	H5932_009_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5932	009	0	1	01	01	H5932_009_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5932	009	0	1	01	01	H5932_009_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5938	001	0	1	01	01	H5938_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5938	001	0	1	01	01	H5938_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5938	001	0	1	01	01	H5938_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5938	001	0	1	01	01	H5938_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5938	001	0	1	01	01	H5938_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5938	001	0	1	01	01	H5938_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5938	006	0	1	01	01	H5938_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5938	006	0	1	01	01	H5938_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5938	006	0	1	01	01	H5938_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5938	006	0	1	01	01	H5938_006_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5938	006	0	1	01	01	H5938_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5938	006	0	1	01	01	H5938_006_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5938	008	0	1	01	01	H5938_008_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H5938	008	0	1	01	01	H5938_008_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5938	008	0	1	01	01	H5938_008_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5938	008	0	1	01	01	H5938_008_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5938	008	0	1	01	01	H5938_008_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5938	008	0	1	01	01	H5938_008_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5943	001	0	1	02	01	H5943_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5943	001	0	1	02	01	H5943_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5943	001	0	1	02	01	H5943_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5943	001	0	1	02	01	H5943_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5943	001	0	1	02	01	H5943_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5943	002	0	1	02	01	H5943_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5943	002	0	1	02	01	H5943_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5943	002	0	1	02	01	H5943_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5943	002	0	1	02	01	H5943_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5943	002	0	1	02	01	H5943_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5945	001	0	1	01	01	H5945_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H5945	001	0	1	01	01	H5945_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5945	001	0	1	01	01	H5945_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5945	001	0	1	01	01	H5945_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5945	001	0	1	01	01	H5945_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5945	001	0	1	01	01	H5945_001_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5945	002	0	1	01	01	H5945_002_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H5945	002	0	1	01	01	H5945_002_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5945	002	0	1	01	01	H5945_002_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5945	002	0	1	01	01	H5945_002_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5945	002	0	1	01	01	H5945_002_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5945	002	0	1	01	01	H5945_002_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5945	008	0	1	01	01	H5945_008_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H5945	008	0	1	01	01	H5945_008_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H5945	008	0	1	01	01	H5945_008_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H5945	008	0	1	01	01	H5945_008_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H5945	008	0	1	01	01	H5945_008_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H5945	008	0	1	01	01	H5945_008_0	11	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H5959	009	0	1	04	01	H5959_009_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5959	009	0	1	04	01	H5959_009_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5959	009	0	1	04	01	H5959_009_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5959	009	0	1	04	01	H5959_009_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5959	009	0	1	04	01	H5959_009_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5959	010	1	1	04	01	H5959_010_1	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5959	010	1	1	04	01	H5959_010_1	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5959	010	1	1	04	01	H5959_010_1	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5959	010	1	1	04	01	H5959_010_1	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5959	010	1	1	04	01	H5959_010_1	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5959	010	2	1	04	01	H5959_010_2	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5959	010	2	1	04	01	H5959_010_2	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5959	010	2	1	04	01	H5959_010_2	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5959	010	2	1	04	01	H5959_010_2	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5959	010	2	1	04	01	H5959_010_2	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5959	011	0	1	04	01	H5959_011_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5959	011	0	1	04	01	H5959_011_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5959	011	0	1	04	01	H5959_011_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5959	011	0	1	04	01	H5959_011_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5959	011	0	1	04	01	H5959_011_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5959	012	0	1	04	01	H5959_012_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5959	012	0	1	04	01	H5959_012_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5959	012	0	1	04	01	H5959_012_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5959	012	0	1	04	01	H5959_012_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5959	012	0	1	04	01	H5959_012_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5959	013	1	1	04	01	H5959_013_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5959	013	1	1	04	01	H5959_013_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5959	013	1	1	04	01	H5959_013_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5959	013	1	1	04	01	H5959_013_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5959	013	1	1	04	01	H5959_013_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5959	013	2	1	04	01	H5959_013_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5959	013	2	1	04	01	H5959_013_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5959	013	2	1	04	01	H5959_013_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5959	013	2	1	04	01	H5959_013_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5959	013	2	1	04	01	H5959_013_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5959	014	1	1	04	01	H5959_014_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5959	014	1	1	04	01	H5959_014_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5959	014	1	1	04	01	H5959_014_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5959	014	1	1	04	01	H5959_014_1	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5959	014	1	1	04	01	H5959_014_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5959	014	2	1	04	01	H5959_014_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5959	014	2	1	04	01	H5959_014_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5959	014	2	1	04	01	H5959_014_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5959	014	2	1	04	01	H5959_014_2	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5959	014	2	1	04	01	H5959_014_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5965	001	0	1	04	01	H5965_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5965	001	0	1	04	01	H5965_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5965	001	0	1	04	01	H5965_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5965	001	0	1	04	01	H5965_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5965	001	0	1	04	01	H5965_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5965	002	0	1	04	01	H5965_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H5965	002	0	1	04	01	H5965_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5965	002	0	1	04	01	H5965_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5965	002	0	1	04	01	H5965_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5965	002	0	1	04	01	H5965_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5970	001	0	1	04	01	H5970_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5970	001	0	1	04	01	H5970_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5970	001	0	1	04	01	H5970_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5970	001	0	1	04	01	H5970_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5970	001	0	1	04	01	H5970_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5970	015	0	1	04	01	H5970_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5970	015	0	1	04	01	H5970_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5970	015	0	1	04	01	H5970_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5970	015	0	1	04	01	H5970_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5970	015	0	1	04	01	H5970_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5970	018	0	1	04	01	H5970_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5970	018	0	1	04	01	H5970_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5970	018	0	1	04	01	H5970_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5970	018	0	1	04	01	H5970_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5970	018	0	1	04	01	H5970_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5970	019	0	1	04	01	H5970_019_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5970	019	0	1	04	01	H5970_019_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5970	019	0	1	04	01	H5970_019_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5970	019	0	1	04	01	H5970_019_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5970	019	0	1	04	01	H5970_019_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5970	020	0	1	04	01	H5970_020_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5970	020	0	1	04	01	H5970_020_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5970	020	0	1	04	01	H5970_020_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5970	020	0	1	04	01	H5970_020_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5970	020	0	1	04	01	H5970_020_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5970	024	1	1	04	01	H5970_024_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5970	024	1	1	04	01	H5970_024_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5970	024	1	1	04	01	H5970_024_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5970	024	1	1	04	01	H5970_024_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5970	024	1	1	04	01	H5970_024_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5970	024	2	1	04	01	H5970_024_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H5970	024	2	1	04	01	H5970_024_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H5970	024	2	1	04	01	H5970_024_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5970	024	2	1	04	01	H5970_024_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5970	024	2	1	04	01	H5970_024_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5989	011	0	1	01	01	H5989_011_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5989	011	0	1	01	01	H5989_011_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5989	011	0	1	01	01	H5989_011_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H5989	011	0	1	01	01	H5989_011_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5989	011	0	1	01	01	H5989_011_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5991	003	0	1	01	01	H5991_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5991	003	0	1	01	01	H5991_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5991	003	0	1	01	01	H5991_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5991	003	0	1	01	01	H5991_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5991	003	0	1	01	01	H5991_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5991	006	0	1	01	01	H5991_006_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5991	006	0	1	01	01	H5991_006_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5991	006	0	1	01	01	H5991_006_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5991	006	0	1	01	01	H5991_006_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5991	006	0	1	01	01	H5991_006_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H5991	009	0	1	01	01	H5991_009_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H5991	009	0	1	01	01	H5991_009_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H5991	009	0	1	01	01	H5991_009_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H5991	009	0	1	01	01	H5991_009_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H5991	009	0	1	01	01	H5991_009_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6067	001	1	1	01	01	H6067_001_1	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6067	001	1	1	01	01	H6067_001_1	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6067	001	1	1	01	01	H6067_001_1	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6067	001	1	1	01	01	H6067_001_1	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6067	001	1	1	01	01	H6067_001_1	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6067	001	2	1	01	01	H6067_001_2	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6067	001	2	1	01	01	H6067_001_2	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6067	001	2	1	01	01	H6067_001_2	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6067	001	2	1	01	01	H6067_001_2	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6067	001	2	1	01	01	H6067_001_2	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6067	002	1	1	01	01	H6067_002_1	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6067	002	1	1	01	01	H6067_002_1	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6067	002	1	1	01	01	H6067_002_1	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6067	002	1	1	01	01	H6067_002_1	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6067	002	1	1	01	01	H6067_002_1	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6067	002	2	1	01	01	H6067_002_2	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6067	002	2	1	01	01	H6067_002_2	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6067	002	2	1	01	01	H6067_002_2	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6067	002	2	1	01	01	H6067_002_2	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6067	002	2	1	01	01	H6067_002_2	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6080	001	0	1	48	05	H6080_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H6080	001	0	1	48	05	H6080_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H6080	001	0	1	48	05	H6080_001_0	3	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H6121	003	0	1	01	01	H6121_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6121	003	0	1	01	01	H6121_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6121	003	0	1	01	01	H6121_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6121	003	0	1	01	01	H6121_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6121	003	0	1	01	01	H6121_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6121	003	0	1	01	01	H6121_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H6121	008	0	1	01	01	H6121_008_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6121	008	0	1	01	01	H6121_008_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6121	008	0	1	01	01	H6121_008_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6121	008	0	1	01	01	H6121_008_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6121	008	0	1	01	01	H6121_008_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6121	008	0	1	01	01	H6121_008_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H6154	001	0	1	02	01	H6154_001_0	5	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6154	001	0	1	02	01	H6154_001_0	5	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6154	001	0	1	02	01	H6154_001_0	5	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6154	001	0	1	02	01	H6154_001_0	5	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6154	001	0	1	02	01	H6154_001_0	5	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6154	002	0	1	02	01	H6154_002_0	5	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6154	002	0	1	02	01	H6154_002_0	5	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6154	002	0	1	02	01	H6154_002_0	5	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6154	002	0	1	02	01	H6154_002_0	5	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6154	002	0	1	02	01	H6154_002_0	5	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6154	003	0	1	01	01	H6154_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6154	003	0	1	01	01	H6154_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6154	003	0	1	01	01	H6154_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6154	003	0	1	01	01	H6154_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6154	003	0	1	01	01	H6154_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6154	004	0	1	01	01	H6154_004_0	6	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6154	004	0	1	01	01	H6154_004_0	6	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6154	004	0	1	01	01	H6154_004_0	6	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6154	004	0	1	01	01	H6154_004_0	6	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6154	004	0	1	01	01	H6154_004_0	6	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6158	001	0	1	01	01	H6158_001_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6158	001	0	1	01	01	H6158_001_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6158	001	0	1	01	01	H6158_001_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6158	001	0	1	01	01	H6158_001_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6158	001	0	1	01	01	H6158_001_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6158	001	0	1	01	01	H6158_001_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H6158	002	0	1	01	01	H6158_002_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6158	002	0	1	01	01	H6158_002_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6158	002	0	1	01	01	H6158_002_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6158	002	0	1	01	01	H6158_002_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6158	002	0	1	01	01	H6158_002_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6158	002	0	1	01	01	H6158_002_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H6202	001	0	1	04	01	H6202_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6202	001	0	1	04	01	H6202_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6202	001	0	1	04	01	H6202_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6202	001	0	1	04	01	H6202_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6202	001	0	1	04	01	H6202_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6202	002	0	1	04	01	H6202_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6202	002	0	1	04	01	H6202_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6202	002	0	1	04	01	H6202_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6202	002	0	1	04	01	H6202_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6202	002	0	1	04	01	H6202_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6229	005	0	1	48	05	H6229_005_0	7	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	2	11					1	0.00	0.00
H6229	005	0	1	48	05	H6229_005_0	7	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	2	11					1	0.00	0.00
H6229	005	0	1	48	05	H6229_005_0	7	Non-Medicare Rx Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	3	2	11					2	0.00	0.00
H6229	005	0	1	48	05	H6229_005_0	7	Non-Medicare OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	4	2	11					2	0.00	0.00
H6229	006	0	1	48	05	H6229_006_0	8	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	2	11					1	0.00	0.00
H6229	006	0	1	48	05	H6229_006_0	8	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	2	11					1	0.00	0.00
H6229	006	0	1	48	05	H6229_006_0	8	Non-Medicare Rx Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	3	2	11					2	0.00	0.00
H6229	006	0	1	48	05	H6229_006_0	8	Non-Medicare OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	4	2	11					2	0.00	0.00
H6237	007	1	1	01	01	H6237_007_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6237	007	1	1	01	01	H6237_007_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6237	007	1	1	01	01	H6237_007_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6237	007	1	1	01	01	H6237_007_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6237	007	1	1	01	01	H6237_007_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6237	007	2	1	01	01	H6237_007_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6237	007	2	1	01	01	H6237_007_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6237	007	2	1	01	01	H6237_007_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6237	007	2	1	01	01	H6237_007_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6237	007	2	1	01	01	H6237_007_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6237	007	3	1	01	01	H6237_007_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6237	007	3	1	01	01	H6237_007_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6237	007	3	1	01	01	H6237_007_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6237	007	3	1	01	01	H6237_007_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6237	007	3	1	01	01	H6237_007_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6237	008	1	1	01	01	H6237_008_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6237	008	1	1	01	01	H6237_008_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6237	008	1	1	01	01	H6237_008_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6237	008	1	1	01	01	H6237_008_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6237	008	1	1	01	01	H6237_008_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6237	008	2	1	01	01	H6237_008_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6237	008	2	1	01	01	H6237_008_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6237	008	2	1	01	01	H6237_008_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6237	008	2	1	01	01	H6237_008_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6237	008	2	1	01	01	H6237_008_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6237	008	3	1	01	01	H6237_008_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6237	008	3	1	01	01	H6237_008_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6237	008	3	1	01	01	H6237_008_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6237	008	3	1	01	01	H6237_008_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6237	008	3	1	01	01	H6237_008_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6306	005	0	1	01	01	H6306_005_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6306	005	0	1	01	01	H6306_005_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6306	005	0	1	01	01	H6306_005_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6306	005	0	1	01	01	H6306_005_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6306	005	0	1	01	01	H6306_005_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6306	011	1	1	02	01	H6306_011_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6306	011	1	1	02	01	H6306_011_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6306	011	1	1	02	01	H6306_011_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6306	011	1	1	02	01	H6306_011_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6306	011	1	1	02	01	H6306_011_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6306	011	3	1	02	01	H6306_011_3	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6306	011	3	1	02	01	H6306_011_3	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6306	011	3	1	02	01	H6306_011_3	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6306	011	3	1	02	01	H6306_011_3	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6306	011	3	1	02	01	H6306_011_3	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6306	012	1	1	02	01	H6306_012_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6306	012	1	1	02	01	H6306_012_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6306	012	1	1	02	01	H6306_012_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6306	012	1	1	02	01	H6306_012_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6306	012	1	1	02	01	H6306_012_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6306	012	5	1	02	01	H6306_012_5	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6306	012	5	1	02	01	H6306_012_5	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6306	012	5	1	02	01	H6306_012_5	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6306	012	5	1	02	01	H6306_012_5	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6306	012	5	1	02	01	H6306_012_5	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6306	013	0	1	02	01	H6306_013_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6306	013	0	1	02	01	H6306_013_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6306	013	0	1	02	01	H6306_013_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6306	013	0	1	02	01	H6306_013_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6306	013	0	1	02	01	H6306_013_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6306	014	0	1	02	01	H6306_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6306	014	0	1	02	01	H6306_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6306	014	0	1	02	01	H6306_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6306	014	0	1	02	01	H6306_014_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6306	014	0	1	02	01	H6306_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6316	001	0	1	01	01	H6316_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6316	001	0	1	01	01	H6316_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6316	001	0	1	01	01	H6316_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6316	001	0	1	01	01	H6316_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6316	001	0	1	01	01	H6316_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6316	001	0	1	01	01	H6316_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H6316	002	0	1	01	01	H6316_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6316	002	0	1	01	01	H6316_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6316	002	0	1	01	01	H6316_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6316	002	0	1	01	01	H6316_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6316	002	0	1	01	01	H6316_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6316	002	0	1	01	01	H6316_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H6328	001	0	1	04	01	H6328_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6328	001	0	1	04	01	H6328_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6328	001	0	1	04	01	H6328_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6328	001	0	1	04	01	H6328_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6328	001	0	1	04	01	H6328_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6328	002	0	1	04	01	H6328_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6328	002	0	1	04	01	H6328_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6328	002	0	1	04	01	H6328_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6328	002	0	1	04	01	H6328_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6328	002	0	1	04	01	H6328_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6328	003	0	1	04	01	H6328_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6328	003	0	1	04	01	H6328_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6328	003	0	1	04	01	H6328_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6328	003	0	1	04	01	H6328_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6328	003	0	1	04	01	H6328_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6348	001	0	1	04	01	H6348_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6348	001	0	1	04	01	H6348_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6348	001	0	1	04	01	H6348_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6348	001	0	1	04	01	H6348_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6348	001	0	1	04	01	H6348_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6348	001	0	1	04	01	H6348_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6348	002	0	1	04	01	H6348_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6348	002	0	1	04	01	H6348_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6348	002	0	1	04	01	H6348_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6348	002	0	1	04	01	H6348_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6348	002	0	1	04	01	H6348_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6348	002	0	1	04	01	H6348_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6351	003	0	1	01	01	H6351_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H6351	003	0	1	01	01	H6351_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H6351	003	0	1	01	01	H6351_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H6351	003	0	1	01	01	H6351_003_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H6351	003	0	1	01	01	H6351_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6379	001	0	1	01	01	H6379_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6379	001	0	1	01	01	H6379_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H6379	001	0	1	01	01	H6379_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H6379	001	0	1	01	01	H6379_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H6379	001	0	1	01	01	H6379_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6396	001	0	1	01	01	H6396_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6396	001	0	1	01	01	H6396_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6396	001	0	1	01	01	H6396_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6396	001	0	1	01	01	H6396_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6396	001	0	1	01	01	H6396_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6396	001	0	1	01	01	H6396_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6396	004	0	1	01	01	H6396_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6396	004	0	1	01	01	H6396_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6396	004	0	1	01	01	H6396_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6396	004	0	1	01	01	H6396_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6396	004	0	1	01	01	H6396_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6396	004	0	1	01	01	H6396_004_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6396	005	0	1	01	01	H6396_005_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6396	005	0	1	01	01	H6396_005_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6396	005	0	1	01	01	H6396_005_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6396	005	0	1	01	01	H6396_005_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6396	005	0	1	01	01	H6396_005_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6396	005	0	1	01	01	H6396_005_0	4	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6396	011	0	1	01	01	H6396_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6396	011	0	1	01	01	H6396_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6396	011	0	1	01	01	H6396_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6396	011	0	1	01	01	H6396_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6396	011	0	1	01	01	H6396_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6396	011	0	1	01	01	H6396_011_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6396	012	0	1	01	01	H6396_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6396	012	0	1	01	01	H6396_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6396	012	0	1	01	01	H6396_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6396	012	0	1	01	01	H6396_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6396	012	0	1	01	01	H6396_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6396	012	0	1	01	01	H6396_012_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6396	013	0	1	01	01	H6396_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6396	013	0	1	01	01	H6396_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6396	013	0	1	01	01	H6396_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6396	013	0	1	01	01	H6396_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6396	013	0	1	01	01	H6396_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6396	013	0	1	01	01	H6396_013_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6396	014	0	1	01	01	H6396_014_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6396	014	0	1	01	01	H6396_014_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6396	014	0	1	01	01	H6396_014_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6396	014	0	1	01	01	H6396_014_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6396	014	0	1	01	01	H6396_014_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6396	014	0	1	01	01	H6396_014_0	3	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6396	015	0	1	01	01	H6396_015_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6396	015	0	1	01	01	H6396_015_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6396	015	0	1	01	01	H6396_015_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6396	015	0	1	01	01	H6396_015_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6396	015	0	1	01	01	H6396_015_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6396	015	0	1	01	01	H6396_015_0	4	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6399	001	0	1	01	01	H6399_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6399	001	0	1	01	01	H6399_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6399	001	0	1	01	01	H6399_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6399	001	0	1	01	01	H6399_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6399	001	0	1	01	01	H6399_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6439	002	0	1	01	01	H6439_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6439	002	0	1	01	01	H6439_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6439	002	0	1	01	01	H6439_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6439	002	0	1	01	01	H6439_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6439	002	0	1	01	01	H6439_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6439	003	0	1	01	01	H6439_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6439	003	0	1	01	01	H6439_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6439	003	0	1	01	01	H6439_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6439	003	0	1	01	01	H6439_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6439	003	0	1	01	01	H6439_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6439	004	0	1	01	01	H6439_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6439	004	0	1	01	01	H6439_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6439	004	0	1	01	01	H6439_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6439	004	0	1	01	01	H6439_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6439	004	0	1	01	01	H6439_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6446	001	0	1	01	01	H6446_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6446	001	0	1	01	01	H6446_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6446	001	0	1	01	01	H6446_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6446	001	0	1	01	01	H6446_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6446	001	0	1	01	01	H6446_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6446	001	0	1	01	01	H6446_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6446	003	0	1	01	01	H6446_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6446	003	0	1	01	01	H6446_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6446	003	0	1	01	01	H6446_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6446	003	0	1	01	01	H6446_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6446	003	0	1	01	01	H6446_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6446	003	0	1	01	01	H6446_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6446	004	0	1	01	01	H6446_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6446	004	0	1	01	01	H6446_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6446	004	0	1	01	01	H6446_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6446	004	0	1	01	01	H6446_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6446	004	0	1	01	01	H6446_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6446	004	0	1	01	01	H6446_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6446	005	0	1	01	01	H6446_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6446	005	0	1	01	01	H6446_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6446	005	0	1	01	01	H6446_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6446	005	0	1	01	01	H6446_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6446	005	0	1	01	01	H6446_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6446	005	0	1	01	01	H6446_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6446	009	0	1	01	01	H6446_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6446	009	0	1	01	01	H6446_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6446	009	0	1	01	01	H6446_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6446	009	0	1	01	01	H6446_009_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6446	009	0	1	01	01	H6446_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6446	009	0	1	01	01	H6446_009_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6446	010	0	1	01	01	H6446_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6446	010	0	1	01	01	H6446_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6446	010	0	1	01	01	H6446_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6446	010	0	1	01	01	H6446_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6446	010	0	1	01	01	H6446_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6446	010	0	1	01	01	H6446_010_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6446	011	0	1	01	01	H6446_011_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6446	011	0	1	01	01	H6446_011_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6446	011	0	1	01	01	H6446_011_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6446	011	0	1	01	01	H6446_011_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6446	011	0	1	01	01	H6446_011_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6446	012	0	1	01	01	H6446_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6446	012	0	1	01	01	H6446_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6446	012	0	1	01	01	H6446_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6446	012	0	1	01	01	H6446_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6446	012	0	1	01	01	H6446_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6446	013	0	1	01	01	H6446_013_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6446	013	0	1	01	01	H6446_013_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6446	013	0	1	01	01	H6446_013_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6446	013	0	1	01	01	H6446_013_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6446	013	0	1	01	01	H6446_013_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6446	014	0	1	01	01	H6446_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6446	014	0	1	01	01	H6446_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6446	014	0	1	01	01	H6446_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6446	014	0	1	01	01	H6446_014_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6446	014	0	1	01	01	H6446_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6446	015	0	1	01	01	H6446_015_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6446	015	0	1	01	01	H6446_015_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6446	015	0	1	01	01	H6446_015_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6446	015	0	1	01	01	H6446_015_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6446	015	0	1	01	01	H6446_015_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6446	016	0	1	01	01	H6446_016_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6446	016	0	1	01	01	H6446_016_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6446	016	0	1	01	01	H6446_016_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6446	016	0	1	01	01	H6446_016_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6446	016	0	1	01	01	H6446_016_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	005	0	1	01	01	H6453_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	005	0	1	01	01	H6453_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	005	0	1	01	01	H6453_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	005	0	1	01	01	H6453_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	005	0	1	01	01	H6453_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	006	0	1	01	01	H6453_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	006	0	1	01	01	H6453_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	006	0	1	01	01	H6453_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	006	0	1	01	01	H6453_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	006	0	1	01	01	H6453_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	007	1	1	01	01	H6453_007_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	007	1	1	01	01	H6453_007_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	007	1	1	01	01	H6453_007_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	007	1	1	01	01	H6453_007_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	007	1	1	01	01	H6453_007_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	007	2	1	01	01	H6453_007_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	007	2	1	01	01	H6453_007_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	007	2	1	01	01	H6453_007_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	007	2	1	01	01	H6453_007_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	007	2	1	01	01	H6453_007_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	008	1	1	01	01	H6453_008_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	008	1	1	01	01	H6453_008_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	008	1	1	01	01	H6453_008_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	008	1	1	01	01	H6453_008_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	008	1	1	01	01	H6453_008_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	008	2	1	01	01	H6453_008_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	008	2	1	01	01	H6453_008_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	008	2	1	01	01	H6453_008_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	008	2	1	01	01	H6453_008_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	008	2	1	01	01	H6453_008_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	009	1	1	01	01	H6453_009_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	009	1	1	01	01	H6453_009_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	009	1	1	01	01	H6453_009_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	009	1	1	01	01	H6453_009_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	009	1	1	01	01	H6453_009_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	009	2	1	01	01	H6453_009_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	009	2	1	01	01	H6453_009_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	009	2	1	01	01	H6453_009_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	009	2	1	01	01	H6453_009_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	009	2	1	01	01	H6453_009_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	010	1	1	01	01	H6453_010_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	010	1	1	01	01	H6453_010_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	010	1	1	01	01	H6453_010_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	010	1	1	01	01	H6453_010_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	010	1	1	01	01	H6453_010_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6453	010	2	1	01	01	H6453_010_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6453	010	2	1	01	01	H6453_010_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6453	010	2	1	01	01	H6453_010_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6453	010	2	1	01	01	H6453_010_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6453	010	2	1	01	01	H6453_010_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6502	001	0	1	04	01	H6502_001_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6502	001	0	1	04	01	H6502_001_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6502	001	0	1	04	01	H6502_001_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6502	001	0	1	04	01	H6502_001_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6502	001	0	1	04	01	H6502_001_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6502	002	0	1	04	01	H6502_002_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6502	002	0	1	04	01	H6502_002_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6502	002	0	1	04	01	H6502_002_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6502	002	0	1	04	01	H6502_002_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6502	002	0	1	04	01	H6502_002_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6526	001	0	1	01	01	H6526_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6526	001	0	1	01	01	H6526_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H6526	001	0	1	01	01	H6526_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6526	001	0	1	01	01	H6526_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6526	001	0	1	01	01	H6526_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6526	002	0	1	01	01	H6526_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6526	002	0	1	01	01	H6526_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H6526	002	0	1	01	01	H6526_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6526	002	0	1	01	01	H6526_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6526	002	0	1	01	01	H6526_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6528	006	0	1	04	01	H6528_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6528	006	0	1	04	01	H6528_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H6528	006	0	1	04	01	H6528_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6528	006	0	1	04	01	H6528_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6528	006	0	1	04	01	H6528_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6528	031	0	1	04	01	H6528_031_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6528	031	0	1	04	01	H6528_031_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H6528	031	0	1	04	01	H6528_031_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6528	031	0	1	04	01	H6528_031_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6528	031	0	1	04	01	H6528_031_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6528	032	0	1	04	01	H6528_032_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6528	032	0	1	04	01	H6528_032_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H6528	032	0	1	04	01	H6528_032_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6528	032	0	1	04	01	H6528_032_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6528	032	0	1	04	01	H6528_032_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6528	033	0	1	04	01	H6528_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6528	033	0	1	04	01	H6528_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H6528	033	0	1	04	01	H6528_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6528	033	0	1	04	01	H6528_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6528	033	0	1	04	01	H6528_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6529	001	1	1	01	01	H6529_001_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6529	001	1	1	01	01	H6529_001_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6529	001	1	1	01	01	H6529_001_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6529	001	1	1	01	01	H6529_001_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6529	001	1	1	01	01	H6529_001_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6529	001	2	1	01	01	H6529_001_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6529	001	2	1	01	01	H6529_001_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6529	001	2	1	01	01	H6529_001_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6529	001	2	1	01	01	H6529_001_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6529	001	2	1	01	01	H6529_001_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6550	003	0	1	01	01	H6550_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6550	003	0	1	01	01	H6550_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6550	003	0	1	01	01	H6550_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6550	003	0	1	01	01	H6550_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6550	003	0	1	01	01	H6550_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6550	003	0	1	01	01	H6550_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6550	004	0	1	01	01	H6550_004_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6550	004	0	1	01	01	H6550_004_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6550	004	0	1	01	01	H6550_004_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6550	004	0	1	01	01	H6550_004_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6550	004	0	1	01	01	H6550_004_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6550	005	0	1	01	01	H6550_005_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6550	005	0	1	01	01	H6550_005_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6550	005	0	1	01	01	H6550_005_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6550	005	0	1	01	01	H6550_005_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6550	005	0	1	01	01	H6550_005_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6550	006	0	1	01	01	H6550_006_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6550	006	0	1	01	01	H6550_006_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6550	006	0	1	01	01	H6550_006_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6550	006	0	1	01	01	H6550_006_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6550	006	0	1	01	01	H6550_006_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6550	007	0	1	01	01	H6550_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6550	007	0	1	01	01	H6550_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6550	007	0	1	01	01	H6550_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6550	007	0	1	01	01	H6550_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6550	007	0	1	01	01	H6550_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6550	007	0	1	01	01	H6550_007_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6594	001	0	1	04	01	H6594_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6594	001	0	1	04	01	H6594_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6594	001	0	1	04	01	H6594_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6594	001	0	1	04	01	H6594_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6594	001	0	1	04	01	H6594_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6594	002	0	1	04	01	H6594_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6594	002	0	1	04	01	H6594_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6594	002	0	1	04	01	H6594_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6594	002	0	1	04	01	H6594_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6594	002	0	1	04	01	H6594_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6594	003	0	1	04	01	H6594_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6594	003	0	1	04	01	H6594_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6594	003	0	1	04	01	H6594_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6594	003	0	1	04	01	H6594_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6594	003	0	1	04	01	H6594_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	001	0	1	01	01	H6622_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	001	0	1	01	01	H6622_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	001	0	1	01	01	H6622_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	001	0	1	01	01	H6622_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	001	0	1	01	01	H6622_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	002	0	1	01	01	H6622_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	002	0	1	01	01	H6622_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	002	0	1	01	01	H6622_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	002	0	1	01	01	H6622_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	002	0	1	01	01	H6622_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	004	0	1	01	01	H6622_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	004	0	1	01	01	H6622_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	004	0	1	01	01	H6622_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	004	0	1	01	01	H6622_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	004	0	1	01	01	H6622_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	005	0	1	01	01	H6622_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	005	0	1	01	01	H6622_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	005	0	1	01	01	H6622_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	005	0	1	01	01	H6622_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	005	0	1	01	01	H6622_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	007	0	1	01	01	H6622_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	007	0	1	01	01	H6622_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	007	0	1	01	01	H6622_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	007	0	1	01	01	H6622_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	007	0	1	01	01	H6622_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	008	0	1	01	01	H6622_008_0	5	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	008	0	1	01	01	H6622_008_0	5	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	008	0	1	01	01	H6622_008_0	5	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	008	0	1	01	01	H6622_008_0	5	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	008	0	1	01	01	H6622_008_0	5	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	010	0	1	01	01	H6622_010_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	010	0	1	01	01	H6622_010_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	010	0	1	01	01	H6622_010_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	010	0	1	01	01	H6622_010_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	010	0	1	01	01	H6622_010_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	011	0	1	01	01	H6622_011_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	011	0	1	01	01	H6622_011_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	011	0	1	01	01	H6622_011_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	011	0	1	01	01	H6622_011_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	011	0	1	01	01	H6622_011_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	013	0	1	01	01	H6622_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	013	0	1	01	01	H6622_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	013	0	1	01	01	H6622_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	013	0	1	01	01	H6622_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	013	0	1	01	01	H6622_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	014	0	1	01	01	H6622_014_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	014	0	1	01	01	H6622_014_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	014	0	1	01	01	H6622_014_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	014	0	1	01	01	H6622_014_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	014	0	1	01	01	H6622_014_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	015	0	1	01	01	H6622_015_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	015	0	1	01	01	H6622_015_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	015	0	1	01	01	H6622_015_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	015	0	1	01	01	H6622_015_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	015	0	1	01	01	H6622_015_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	016	0	1	01	01	H6622_016_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	016	0	1	01	01	H6622_016_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	016	0	1	01	01	H6622_016_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	016	0	1	01	01	H6622_016_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	016	0	1	01	01	H6622_016_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	017	0	1	01	01	H6622_017_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6622	017	0	1	01	01	H6622_017_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6622	017	0	1	01	01	H6622_017_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6622	017	0	1	01	01	H6622_017_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6622	017	0	1	01	01	H6622_017_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6622	017	0	1	01	01	H6622_017_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6622	018	0	1	01	01	H6622_018_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	018	0	1	01	01	H6622_018_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	018	0	1	01	01	H6622_018_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	018	0	1	01	01	H6622_018_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	018	0	1	01	01	H6622_018_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	019	0	1	01	01	H6622_019_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	019	0	1	01	01	H6622_019_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	019	0	1	01	01	H6622_019_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	019	0	1	01	01	H6622_019_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	019	0	1	01	01	H6622_019_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	021	1	1	01	01	H6622_021_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	021	1	1	01	01	H6622_021_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	021	1	1	01	01	H6622_021_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	021	1	1	01	01	H6622_021_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	021	1	1	01	01	H6622_021_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	021	2	1	01	01	H6622_021_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	021	2	1	01	01	H6622_021_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	021	2	1	01	01	H6622_021_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	021	2	1	01	01	H6622_021_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	021	2	1	01	01	H6622_021_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	022	0	1	01	01	H6622_022_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	022	0	1	01	01	H6622_022_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	022	0	1	01	01	H6622_022_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	022	0	1	01	01	H6622_022_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	022	0	1	01	01	H6622_022_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	023	0	1	01	01	H6622_023_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	023	0	1	01	01	H6622_023_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	023	0	1	01	01	H6622_023_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	023	0	1	01	01	H6622_023_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	023	0	1	01	01	H6622_023_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	025	0	1	02	01	H6622_025_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	025	0	1	02	01	H6622_025_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	025	0	1	02	01	H6622_025_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	025	0	1	02	01	H6622_025_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	025	0	1	02	01	H6622_025_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	026	0	1	01	01	H6622_026_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	026	0	1	01	01	H6622_026_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	026	0	1	01	01	H6622_026_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	026	0	1	01	01	H6622_026_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	026	0	1	01	01	H6622_026_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	027	0	1	01	01	H6622_027_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	027	0	1	01	01	H6622_027_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	027	0	1	01	01	H6622_027_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	027	0	1	01	01	H6622_027_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	027	0	1	01	01	H6622_027_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	028	0	1	01	01	H6622_028_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6622	028	0	1	01	01	H6622_028_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	028	0	1	01	01	H6622_028_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	028	0	1	01	01	H6622_028_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	028	0	1	01	01	H6622_028_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	029	0	1	01	01	H6622_029_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6622	029	0	1	01	01	H6622_029_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	029	0	1	01	01	H6622_029_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	029	0	1	01	01	H6622_029_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	029	0	1	01	01	H6622_029_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	030	0	1	01	01	H6622_030_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6622	030	0	1	01	01	H6622_030_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	030	0	1	01	01	H6622_030_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	030	0	1	01	01	H6622_030_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	030	0	1	01	01	H6622_030_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	032	0	1	01	01	H6622_032_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6622	032	0	1	01	01	H6622_032_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	032	0	1	01	01	H6622_032_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	032	0	1	01	01	H6622_032_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	032	0	1	01	01	H6622_032_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	033	0	1	01	01	H6622_033_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6622	033	0	1	01	01	H6622_033_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	033	0	1	01	01	H6622_033_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	033	0	1	01	01	H6622_033_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	033	0	1	01	01	H6622_033_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	034	0	1	01	01	H6622_034_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	034	0	1	01	01	H6622_034_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	034	0	1	01	01	H6622_034_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	034	0	1	01	01	H6622_034_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	034	0	1	01	01	H6622_034_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	035	0	1	01	01	H6622_035_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	035	0	1	01	01	H6622_035_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	035	0	1	01	01	H6622_035_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	035	0	1	01	01	H6622_035_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	035	0	1	01	01	H6622_035_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	036	0	1	01	01	H6622_036_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	036	0	1	01	01	H6622_036_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	036	0	1	01	01	H6622_036_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	036	0	1	01	01	H6622_036_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	036	0	1	01	01	H6622_036_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	037	0	1	01	01	H6622_037_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	037	0	1	01	01	H6622_037_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	037	0	1	01	01	H6622_037_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	037	0	1	01	01	H6622_037_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	037	0	1	01	01	H6622_037_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	038	0	1	01	01	H6622_038_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	038	0	1	01	01	H6622_038_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	038	0	1	01	01	H6622_038_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	038	0	1	01	01	H6622_038_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	038	0	1	01	01	H6622_038_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	040	0	1	01	01	H6622_040_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	040	0	1	01	01	H6622_040_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	040	0	1	01	01	H6622_040_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	040	0	1	01	01	H6622_040_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	040	0	1	01	01	H6622_040_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	041	0	1	01	01	H6622_041_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	041	0	1	01	01	H6622_041_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	041	0	1	01	01	H6622_041_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	041	0	1	01	01	H6622_041_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	041	0	1	01	01	H6622_041_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	047	0	1	01	01	H6622_047_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	047	0	1	01	01	H6622_047_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	047	0	1	01	01	H6622_047_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	047	0	1	01	01	H6622_047_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	047	0	1	01	01	H6622_047_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	048	0	1	01	01	H6622_048_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	048	0	1	01	01	H6622_048_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	048	0	1	01	01	H6622_048_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	048	0	1	01	01	H6622_048_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	048	0	1	01	01	H6622_048_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	049	0	1	01	01	H6622_049_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	049	0	1	01	01	H6622_049_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	049	0	1	01	01	H6622_049_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	049	0	1	01	01	H6622_049_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	049	0	1	01	01	H6622_049_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	051	0	1	01	01	H6622_051_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	051	0	1	01	01	H6622_051_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	051	0	1	01	01	H6622_051_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	051	0	1	01	01	H6622_051_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	051	0	1	01	01	H6622_051_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	052	0	1	01	01	H6622_052_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	052	0	1	01	01	H6622_052_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	052	0	1	01	01	H6622_052_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	052	0	1	01	01	H6622_052_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	052	0	1	01	01	H6622_052_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	054	0	1	01	01	H6622_054_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	054	0	1	01	01	H6622_054_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	054	0	1	01	01	H6622_054_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	054	0	1	01	01	H6622_054_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	054	0	1	01	01	H6622_054_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	055	0	1	01	01	H6622_055_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	055	0	1	01	01	H6622_055_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	055	0	1	01	01	H6622_055_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	055	0	1	01	01	H6622_055_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	055	0	1	01	01	H6622_055_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	056	0	1	01	01	H6622_056_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6622	056	0	1	01	01	H6622_056_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	056	0	1	01	01	H6622_056_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	056	0	1	01	01	H6622_056_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	056	0	1	01	01	H6622_056_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	057	0	1	01	01	H6622_057_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	057	0	1	01	01	H6622_057_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	057	0	1	01	01	H6622_057_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	057	0	1	01	01	H6622_057_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	057	0	1	01	01	H6622_057_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	059	0	1	01	01	H6622_059_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	059	0	1	01	01	H6622_059_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	059	0	1	01	01	H6622_059_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	059	0	1	01	01	H6622_059_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	059	0	1	01	01	H6622_059_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	060	0	1	01	01	H6622_060_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	060	0	1	01	01	H6622_060_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	060	0	1	01	01	H6622_060_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	060	0	1	01	01	H6622_060_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	060	0	1	01	01	H6622_060_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	061	0	1	01	01	H6622_061_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	061	0	1	01	01	H6622_061_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	061	0	1	01	01	H6622_061_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	061	0	1	01	01	H6622_061_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	061	0	1	01	01	H6622_061_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	062	0	1	02	01	H6622_062_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	062	0	1	02	01	H6622_062_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	062	0	1	02	01	H6622_062_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	062	0	1	02	01	H6622_062_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	062	0	1	02	01	H6622_062_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	063	0	1	01	01	H6622_063_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	063	0	1	01	01	H6622_063_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	063	0	1	01	01	H6622_063_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	063	0	1	01	01	H6622_063_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	063	0	1	01	01	H6622_063_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	064	0	1	01	01	H6622_064_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	064	0	1	01	01	H6622_064_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	064	0	1	01	01	H6622_064_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	064	0	1	01	01	H6622_064_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	064	0	1	01	01	H6622_064_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	066	0	1	01	01	H6622_066_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	066	0	1	01	01	H6622_066_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	066	0	1	01	01	H6622_066_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	066	0	1	01	01	H6622_066_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	066	0	1	01	01	H6622_066_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	069	0	1	01	01	H6622_069_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	069	0	1	01	01	H6622_069_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	069	0	1	01	01	H6622_069_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	069	0	1	01	01	H6622_069_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	069	0	1	01	01	H6622_069_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	070	0	1	01	01	H6622_070_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	070	0	1	01	01	H6622_070_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	070	0	1	01	01	H6622_070_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	070	0	1	01	01	H6622_070_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	070	0	1	01	01	H6622_070_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	071	0	1	01	01	H6622_071_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H6622	071	0	1	01	01	H6622_071_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H6622	071	0	1	01	01	H6622_071_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6622	071	0	1	01	01	H6622_071_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6622	071	0	1	01	01	H6622_071_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6622	071	0	1	01	01	H6622_071_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6622	072	0	1	01	01	H6622_072_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	072	0	1	01	01	H6622_072_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	072	0	1	01	01	H6622_072_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	072	0	1	01	01	H6622_072_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	072	0	1	01	01	H6622_072_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6622	073	0	1	02	01	H6622_073_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6622	073	0	1	02	01	H6622_073_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6622	073	0	1	02	01	H6622_073_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6622	073	0	1	02	01	H6622_073_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6622	073	0	1	02	01	H6622_073_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6672	003	0	1	01	01	H6672_003_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6672	003	0	1	01	01	H6672_003_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6672	003	0	1	01	01	H6672_003_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H6672	003	0	1	01	01	H6672_003_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6672	003	0	1	01	01	H6672_003_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6672	004	0	1	01	01	H6672_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6672	004	0	1	01	01	H6672_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6672	004	0	1	01	01	H6672_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6672	004	0	1	01	01	H6672_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6672	004	0	1	01	01	H6672_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6672	005	0	1	01	01	H6672_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6672	005	0	1	01	01	H6672_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6672	005	0	1	01	01	H6672_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6672	005	0	1	01	01	H6672_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6672	005	0	1	01	01	H6672_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6706	001	0	1	01	01	H6706_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6706	001	0	1	01	01	H6706_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H6706	001	0	1	01	01	H6706_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6706	001	0	1	01	01	H6706_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6706	001	0	1	01	01	H6706_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6713	001	0	1	04	01	H6713_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6713	001	0	1	04	01	H6713_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6713	001	0	1	04	01	H6713_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6713	001	0	1	04	01	H6713_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6713	001	0	1	04	01	H6713_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6713	002	0	1	04	01	H6713_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6713	002	0	1	04	01	H6713_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6713	002	0	1	04	01	H6713_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6713	002	0	1	04	01	H6713_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6713	002	0	1	04	01	H6713_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	001	1	1	01	01	H6723_001_1	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	001	1	1	01	01	H6723_001_1	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	001	1	1	01	01	H6723_001_1	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	001	1	1	01	01	H6723_001_1	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	001	1	1	01	01	H6723_001_1	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	001	2	1	01	01	H6723_001_2	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	001	2	1	01	01	H6723_001_2	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	001	2	1	01	01	H6723_001_2	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	001	2	1	01	01	H6723_001_2	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	001	2	1	01	01	H6723_001_2	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	001	3	1	01	01	H6723_001_3	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	001	3	1	01	01	H6723_001_3	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	001	3	1	01	01	H6723_001_3	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	001	3	1	01	01	H6723_001_3	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	001	3	1	01	01	H6723_001_3	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	002	1	1	01	01	H6723_002_1	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	002	1	1	01	01	H6723_002_1	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	002	1	1	01	01	H6723_002_1	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	002	1	1	01	01	H6723_002_1	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	002	1	1	01	01	H6723_002_1	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	002	2	1	01	01	H6723_002_2	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	002	2	1	01	01	H6723_002_2	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	002	2	1	01	01	H6723_002_2	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	002	2	1	01	01	H6723_002_2	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	002	2	1	01	01	H6723_002_2	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	002	3	1	01	01	H6723_002_3	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	002	3	1	01	01	H6723_002_3	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	002	3	1	01	01	H6723_002_3	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	002	3	1	01	01	H6723_002_3	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	002	3	1	01	01	H6723_002_3	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	003	1	1	01	01	H6723_003_1	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	003	1	1	01	01	H6723_003_1	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	003	1	1	01	01	H6723_003_1	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	003	1	1	01	01	H6723_003_1	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	003	1	1	01	01	H6723_003_1	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	003	2	1	01	01	H6723_003_2	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	003	2	1	01	01	H6723_003_2	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	003	2	1	01	01	H6723_003_2	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	003	2	1	01	01	H6723_003_2	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	003	2	1	01	01	H6723_003_2	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	003	3	1	01	01	H6723_003_3	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	003	3	1	01	01	H6723_003_3	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	003	3	1	01	01	H6723_003_3	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	003	3	1	01	01	H6723_003_3	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	003	3	1	01	01	H6723_003_3	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	005	1	1	01	01	H6723_005_1	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	005	1	1	01	01	H6723_005_1	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	005	1	1	01	01	H6723_005_1	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	005	1	1	01	01	H6723_005_1	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	005	1	1	01	01	H6723_005_1	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	005	2	1	01	01	H6723_005_2	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6723	005	2	1	01	01	H6723_005_2	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6723	005	2	1	01	01	H6723_005_2	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6723	005	2	1	01	01	H6723_005_2	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6723	005	2	1	01	01	H6723_005_2	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6723	006	1	1	01	01	H6723_006_1	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6723	006	1	1	01	01	H6723_006_1	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6723	006	1	1	01	01	H6723_006_1	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6723	006	1	1	01	01	H6723_006_1	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6723	006	1	1	01	01	H6723_006_1	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6723	006	1	1	01	01	H6723_006_1	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H6723	006	2	1	01	01	H6723_006_2	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6723	006	2	1	01	01	H6723_006_2	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6723	006	2	1	01	01	H6723_006_2	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6723	006	2	1	01	01	H6723_006_2	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6723	006	2	1	01	01	H6723_006_2	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6723	006	2	1	01	01	H6723_006_2	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H6743	001	0	1	04	01	H6743_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	001	0	1	04	01	H6743_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	001	0	1	04	01	H6743_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H6743	001	0	1	04	01	H6743_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6743	001	0	1	04	01	H6743_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	10	1						
H6743	001	0	1	04	01	H6743_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	10	1						
H6743	007	0	1	04	01	H6743_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	007	0	1	04	01	H6743_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	007	0	1	04	01	H6743_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6743	007	0	1	04	01	H6743_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	10	1						
H6743	007	0	1	04	01	H6743_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6743	007	0	1	04	01	H6743_007_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6743	018	1	1	04	01	H6743_018_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	018	1	1	04	01	H6743_018_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	018	1	1	04	01	H6743_018_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H6743	018	1	1	04	01	H6743_018_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6743	018	1	1	04	01	H6743_018_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6743	018	1	1	04	01	H6743_018_1	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6743	018	3	1	04	01	H6743_018_3	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	018	3	1	04	01	H6743_018_3	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	018	3	1	04	01	H6743_018_3	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H6743	018	3	1	04	01	H6743_018_3	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6743	018	3	1	04	01	H6743_018_3	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6743	018	3	1	04	01	H6743_018_3	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6743	020	1	1	04	01	H6743_020_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	020	1	1	04	01	H6743_020_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	020	1	1	04	01	H6743_020_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H6743	020	1	1	04	01	H6743_020_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6743	020	1	1	04	01	H6743_020_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6743	020	1	1	04	01	H6743_020_1	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6743	020	2	1	04	01	H6743_020_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	020	2	1	04	01	H6743_020_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	020	2	1	04	01	H6743_020_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H6743	020	2	1	04	01	H6743_020_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6743	020	2	1	04	01	H6743_020_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6743	020	2	1	04	01	H6743_020_2	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6743	020	3	1	04	01	H6743_020_3	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	020	3	1	04	01	H6743_020_3	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	020	3	1	04	01	H6743_020_3	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H6743	020	3	1	04	01	H6743_020_3	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6743	020	3	1	04	01	H6743_020_3	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6743	020	3	1	04	01	H6743_020_3	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6743	020	4	1	04	01	H6743_020_4	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	020	4	1	04	01	H6743_020_4	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	020	4	1	04	01	H6743_020_4	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H6743	020	4	1	04	01	H6743_020_4	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6743	020	4	1	04	01	H6743_020_4	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6743	020	4	1	04	01	H6743_020_4	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6743	021	2	1	04	01	H6743_021_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	021	2	1	04	01	H6743_021_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	021	2	1	04	01	H6743_021_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H6743	021	2	1	04	01	H6743_021_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6743	021	2	1	04	01	H6743_021_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6743	021	2	1	04	01	H6743_021_2	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6743	021	4	1	04	01	H6743_021_4	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6743	021	4	1	04	01	H6743_021_4	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6743	021	4	1	04	01	H6743_021_4	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H6743	021	4	1	04	01	H6743_021_4	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6743	021	4	1	04	01	H6743_021_4	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6743	021	4	1	04	01	H6743_021_4	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6750	005	0	1	01	01	H6750_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H6750	005	0	1	01	01	H6750_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H6750	005	0	1	01	01	H6750_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H6750	005	0	1	01	01	H6750_005_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H6750	005	0	1	01	01	H6750_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6750	006	0	1	01	01	H6750_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H6750	006	0	1	01	01	H6750_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H6750	006	0	1	01	01	H6750_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H6750	006	0	1	01	01	H6750_006_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H6750	006	0	1	01	01	H6750_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6750	007	0	1	01	01	H6750_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H6750	007	0	1	01	01	H6750_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H6750	007	0	1	01	01	H6750_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H6750	007	0	1	01	01	H6750_007_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H6750	007	0	1	01	01	H6750_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6750	008	0	1	01	01	H6750_008_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H6750	008	0	1	01	01	H6750_008_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H6750	008	0	1	01	01	H6750_008_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H6750	008	0	1	01	01	H6750_008_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H6750	008	0	1	01	01	H6750_008_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6750	009	0	1	01	01	H6750_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H6750	009	0	1	01	01	H6750_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H6750	009	0	1	01	01	H6750_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H6750	009	0	1	01	01	H6750_009_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H6750	009	0	1	01	01	H6750_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6750	012	1	1	01	01	H6750_012_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H6750	012	1	1	01	01	H6750_012_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H6750	012	1	1	01	01	H6750_012_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H6750	012	1	1	01	01	H6750_012_1	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H6750	012	1	1	01	01	H6750_012_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6750	012	2	1	01	01	H6750_012_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H6750	012	2	1	01	01	H6750_012_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H6750	012	2	1	01	01	H6750_012_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H6750	012	2	1	01	01	H6750_012_2	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H6750	012	2	1	01	01	H6750_012_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6750	013	0	1	01	01	H6750_013_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H6750	013	0	1	01	01	H6750_013_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H6750	013	0	1	01	01	H6750_013_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H6750	013	0	1	01	01	H6750_013_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H6750	013	0	1	01	01	H6750_013_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6750	014	0	1	02	01	H6750_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	11	3						
H6750	014	0	1	02	01	H6750_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	11	3						
H6750	014	0	1	02	01	H6750_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	11	1						
H6750	014	0	1	02	01	H6750_014_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	11	1						
H6750	014	0	1	02	01	H6750_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6815	005	0	1	01	01	H6815_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H6815	005	0	1	01	01	H6815_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6815	005	0	1	01	01	H6815_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6815	005	0	1	01	01	H6815_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6815	005	0	1	01	01	H6815_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6815	005	0	1	01	01	H6815_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6815	006	0	1	01	01	H6815_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H6815	006	0	1	01	01	H6815_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6815	006	0	1	01	01	H6815_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6815	006	0	1	01	01	H6815_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6815	006	0	1	01	01	H6815_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6815	006	0	1	01	01	H6815_006_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6815	037	0	1	01	01	H6815_037_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H6815	037	0	1	01	01	H6815_037_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6815	037	0	1	01	01	H6815_037_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6815	037	0	1	01	01	H6815_037_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6815	037	0	1	01	01	H6815_037_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6815	038	0	1	01	01	H6815_038_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H6815	038	0	1	01	01	H6815_038_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6815	038	0	1	01	01	H6815_038_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6815	038	0	1	01	01	H6815_038_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6815	038	0	1	01	01	H6815_038_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6815	038	0	1	01	01	H6815_038_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6830	001	0	1	04	01	H6830_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H6830	001	0	1	04	01	H6830_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H6830	001	0	1	04	01	H6830_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H6830	001	0	1	04	01	H6830_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H6830	001	0	1	04	01	H6830_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H6830	001	0	1	04	01	H6830_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H6832	002	0	1	01	01	H6832_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H6832	002	0	1	01	01	H6832_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H6832	002	0	1	01	01	H6832_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H6832	002	0	1	01	01	H6832_002_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H6832	002	0	1	01	01	H6832_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6870	001	0	1	48	05	H6870_001_0	5	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H6870	001	0	1	48	05	H6870_001_0	5	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H6870	001	0	1	48	05	H6870_001_0	5	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H6874	001	0	1	04	01	H6874_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6874	001	0	1	04	01	H6874_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6874	001	0	1	04	01	H6874_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6874	001	0	1	04	01	H6874_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6874	001	0	1	04	01	H6874_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6874	002	0	1	04	01	H6874_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6874	002	0	1	04	01	H6874_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6874	002	0	1	04	01	H6874_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6874	002	0	1	04	01	H6874_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6874	002	0	1	04	01	H6874_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6898	001	0	1	04	01	H6898_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6898	001	0	1	04	01	H6898_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6898	001	0	1	04	01	H6898_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6898	001	0	1	04	01	H6898_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6898	001	0	1	04	01	H6898_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6898	002	0	1	04	01	H6898_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H6898	002	0	1	04	01	H6898_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H6898	002	0	1	04	01	H6898_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6898	002	0	1	04	01	H6898_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6898	002	0	1	04	01	H6898_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6910	001	0	1	01	01	H6910_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6910	001	0	1	01	01	H6910_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H6910	001	0	1	01	01	H6910_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6910	001	0	1	01	01	H6910_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6910	001	0	1	01	01	H6910_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6910	002	0	1	01	01	H6910_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6910	002	0	1	01	01	H6910_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H6910	002	0	1	01	01	H6910_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6910	002	0	1	01	01	H6910_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6910	002	0	1	01	01	H6910_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6910	003	0	1	01	01	H6910_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H6910	003	0	1	01	01	H6910_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H6910	003	0	1	01	01	H6910_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6910	003	0	1	01	01	H6910_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6910	003	0	1	01	01	H6910_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6936	003	0	1	01	01	H6936_003_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H6936	003	0	1	01	01	H6936_003_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H6936	003	0	1	01	01	H6936_003_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H6936	003	0	1	01	01	H6936_003_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H6936	003	0	1	01	01	H6936_003_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6936	004	0	1	01	01	H6936_004_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H6936	004	0	1	01	01	H6936_004_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H6936	004	0	1	01	01	H6936_004_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H6936	004	0	1	01	01	H6936_004_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H6936	004	0	1	01	01	H6936_004_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6936	005	0	1	01	01	H6936_005_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H6936	005	0	1	01	01	H6936_005_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H6936	005	0	1	01	01	H6936_005_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H6936	005	0	1	01	01	H6936_005_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H6936	005	0	1	01	01	H6936_005_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6936	006	0	1	01	01	H6936_006_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H6936	006	0	1	01	01	H6936_006_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H6936	006	0	1	01	01	H6936_006_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H6936	006	0	1	01	01	H6936_006_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H6936	006	0	1	01	01	H6936_006_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H6975	001	0	1	01	01	H6975_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6975	001	0	1	01	01	H6975_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6975	001	0	1	01	01	H6975_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6975	001	0	1	01	01	H6975_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6975	001	0	1	01	01	H6975_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6975	002	0	1	01	01	H6975_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6975	002	0	1	01	01	H6975_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6975	002	0	1	01	01	H6975_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6975	002	0	1	01	01	H6975_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6975	002	0	1	01	01	H6975_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6975	003	0	1	01	01	H6975_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6975	003	0	1	01	01	H6975_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6975	003	0	1	01	01	H6975_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6975	003	0	1	01	01	H6975_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6975	003	0	1	01	01	H6975_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6975	004	0	1	01	01	H6975_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6975	004	0	1	01	01	H6975_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6975	004	0	1	01	01	H6975_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6975	004	0	1	01	01	H6975_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6975	004	0	1	01	01	H6975_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6975	005	0	1	01	01	H6975_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H6975	005	0	1	01	01	H6975_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H6975	005	0	1	01	01	H6975_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H6975	005	0	1	01	01	H6975_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H6975	005	0	1	01	01	H6975_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H6988	001	0	1	01	01	H6988_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H6988	001	0	1	01	01	H6988_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H6988	001	0	1	01	01	H6988_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H6988	001	0	1	01	01	H6988_001_0	6	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H6988	001	0	1	01	01	H6988_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H7006	001	0	1	04	01	H7006_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7006	001	0	1	04	01	H7006_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7006	001	0	1	04	01	H7006_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H7006	001	0	1	04	01	H7006_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7006	001	0	1	04	01	H7006_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7006	001	0	1	04	01	H7006_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7006	003	0	1	04	01	H7006_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7006	003	0	1	04	01	H7006_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7006	003	0	1	04	01	H7006_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H7006	003	0	1	04	01	H7006_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7006	003	0	1	04	01	H7006_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7006	003	0	1	04	01	H7006_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7020	004	0	1	01	01	H7020_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7020	004	0	1	01	01	H7020_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7020	004	0	1	01	01	H7020_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7020	004	0	1	01	01	H7020_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7020	004	0	1	01	01	H7020_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7020	006	0	1	01	01	H7020_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7020	006	0	1	01	01	H7020_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7020	006	0	1	01	01	H7020_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7020	006	0	1	01	01	H7020_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7020	006	0	1	01	01	H7020_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7020	007	0	1	01	01	H7020_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7020	007	0	1	01	01	H7020_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7020	007	0	1	01	01	H7020_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7020	007	0	1	01	01	H7020_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7020	007	0	1	01	01	H7020_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7020	008	0	1	01	01	H7020_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7020	008	0	1	01	01	H7020_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7020	008	0	1	01	01	H7020_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7020	008	0	1	01	01	H7020_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7020	008	0	1	01	01	H7020_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7063	001	0	1	04	01	H7063_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7063	001	0	1	04	01	H7063_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7063	001	0	1	04	01	H7063_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H7063	001	0	1	04	01	H7063_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H7063	001	0	1	04	01	H7063_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H7063	002	0	1	04	01	H7063_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7063	002	0	1	04	01	H7063_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7063	002	0	1	04	01	H7063_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H7063	002	0	1	04	01	H7063_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H7063	002	0	1	04	01	H7063_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H7063	006	0	1	04	01	H7063_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7063	006	0	1	04	01	H7063_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7063	006	0	1	04	01	H7063_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H7063	006	0	1	04	01	H7063_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H7063	006	0	1	04	01	H7063_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H7063	007	0	1	04	01	H7063_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7063	007	0	1	04	01	H7063_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7063	007	0	1	04	01	H7063_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H7063	007	0	1	04	01	H7063_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H7063	007	0	1	04	01	H7063_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
H7076	011	0	1	01	01	H7076_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7076	011	0	1	01	01	H7076_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7076	011	0	1	01	01	H7076_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7076	011	0	1	01	01	H7076_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7076	011	0	1	01	01	H7076_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7076	011	0	1	01	01	H7076_011_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7076	012	0	1	01	01	H7076_012_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7076	012	0	1	01	01	H7076_012_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7076	012	0	1	01	01	H7076_012_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7076	012	0	1	01	01	H7076_012_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7076	012	0	1	01	01	H7076_012_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7076	012	0	1	01	01	H7076_012_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7076	013	0	1	01	01	H7076_013_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7076	013	0	1	01	01	H7076_013_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7076	013	0	1	01	01	H7076_013_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7076	013	0	1	01	01	H7076_013_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7076	013	0	1	01	01	H7076_013_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7076	013	0	1	01	01	H7076_013_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7076	014	0	1	01	01	H7076_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7076	014	0	1	01	01	H7076_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7076	014	0	1	01	01	H7076_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7076	014	0	1	01	01	H7076_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7076	014	0	1	01	01	H7076_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7076	014	0	1	01	01	H7076_014_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7076	015	0	1	01	01	H7076_015_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7076	015	0	1	01	01	H7076_015_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7076	015	0	1	01	01	H7076_015_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7076	015	0	1	01	01	H7076_015_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7076	015	0	1	01	01	H7076_015_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7076	015	0	1	01	01	H7076_015_0	3	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7076	016	0	1	01	01	H7076_016_0	5	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7076	016	0	1	01	01	H7076_016_0	5	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7076	016	0	1	01	01	H7076_016_0	5	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7076	016	0	1	01	01	H7076_016_0	5	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7076	016	0	1	01	01	H7076_016_0	5	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7076	016	0	1	01	01	H7076_016_0	5	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7115	001	0	1	01	01	H7115_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7115	001	0	1	01	01	H7115_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7115	001	0	1	01	01	H7115_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H7115	001	0	1	01	01	H7115_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7115	001	0	1	01	01	H7115_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7115	001	0	1	01	01	H7115_001_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7115	003	0	1	01	01	H7115_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7115	003	0	1	01	01	H7115_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7115	003	0	1	01	01	H7115_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H7115	003	0	1	01	01	H7115_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H7115	003	0	1	01	01	H7115_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7115	003	0	1	01	01	H7115_003_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7123	001	0	1	01	01	H7123_001_0	8	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7123	001	0	1	01	01	H7123_001_0	8	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7123	001	0	1	01	01	H7123_001_0	8	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7123	001	0	1	01	01	H7123_001_0	8	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7123	001	0	1	01	01	H7123_001_0	8	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7149	001	0	1	01	01	H7149_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7149	001	0	1	01	01	H7149_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7149	001	0	1	01	01	H7149_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7149	001	0	1	01	01	H7149_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7149	001	0	1	01	01	H7149_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7149	004	0	1	01	01	H7149_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7149	004	0	1	01	01	H7149_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7149	004	0	1	01	01	H7149_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7149	004	0	1	01	01	H7149_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7149	004	0	1	01	01	H7149_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7149	006	0	1	01	01	H7149_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7149	006	0	1	01	01	H7149_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7149	006	0	1	01	01	H7149_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7149	006	0	1	01	01	H7149_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7149	006	0	1	01	01	H7149_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7163	002	0	1	02	01	H7163_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H7163	002	0	1	02	01	H7163_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H7163	002	0	1	02	01	H7163_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H7163	002	0	1	02	01	H7163_002_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H7163	002	0	1	02	01	H7163_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H7163	003	0	1	02	01	H7163_003_0	7	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H7163	003	0	1	02	01	H7163_003_0	7	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H7163	003	0	1	02	01	H7163_003_0	7	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H7163	003	0	1	02	01	H7163_003_0	7	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H7163	003	0	1	02	01	H7163_003_0	7	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H7163	004	0	1	02	01	H7163_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H7163	004	0	1	02	01	H7163_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H7163	004	0	1	02	01	H7163_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H7163	004	0	1	02	01	H7163_004_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H7163	004	0	1	02	01	H7163_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	10	1						
H7165	001	0	1	01	01	H7165_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7165	001	0	1	01	01	H7165_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7165	001	0	1	01	01	H7165_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7165	001	0	1	01	01	H7165_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7165	001	0	1	01	01	H7165_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7165	002	0	1	01	01	H7165_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7165	002	0	1	01	01	H7165_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7165	002	0	1	01	01	H7165_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7165	002	0	1	01	01	H7165_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7165	002	0	1	01	01	H7165_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7172	001	0	1	48	05	H7172_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	11					1	0.00	0.00
H7172	001	0	1	48	05	H7172_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H7172	001	0	1	48	05	H7172_001_0	3	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H7173	001	0	1	01	01	H7173_001_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7173	001	0	1	01	01	H7173_001_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7173	001	0	1	01	01	H7173_001_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7173	001	0	1	01	01	H7173_001_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7173	001	0	1	01	01	H7173_001_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7173	002	0	1	01	01	H7173_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7173	002	0	1	01	01	H7173_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7173	002	0	1	01	01	H7173_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7173	002	0	1	01	01	H7173_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7173	002	0	1	01	01	H7173_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7173	002	0	1	01	01	H7173_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7173	007	0	1	01	01	H7173_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7173	007	0	1	01	01	H7173_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7173	007	0	1	01	01	H7173_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7173	007	0	1	01	01	H7173_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7173	007	0	1	01	01	H7173_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7173	007	0	1	01	01	H7173_007_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7175	001	0	1	04	01	H7175_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7175	001	0	1	04	01	H7175_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7175	001	0	1	04	01	H7175_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7175	001	0	1	04	01	H7175_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7175	001	0	1	04	01	H7175_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7175	002	0	1	04	01	H7175_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7175	002	0	1	04	01	H7175_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7175	002	0	1	04	01	H7175_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7175	002	0	1	04	01	H7175_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7175	002	0	1	04	01	H7175_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7175	003	0	1	04	01	H7175_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7175	003	0	1	04	01	H7175_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7175	003	0	1	04	01	H7175_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7175	003	0	1	04	01	H7175_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7175	003	0	1	04	01	H7175_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7175	004	0	1	04	01	H7175_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7175	004	0	1	04	01	H7175_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7175	004	0	1	04	01	H7175_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7175	004	0	1	04	01	H7175_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7175	004	0	1	04	01	H7175_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7220	004	0	1	02	01	H7220_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H7220	004	0	1	02	01	H7220_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H7220	004	0	1	02	01	H7220_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H7220	004	0	1	02	01	H7220_004_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H7220	004	0	1	02	01	H7220_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H7220	004	0	1	02	01	H7220_004_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H7220	009	1	1	01	01	H7220_009_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H7220	009	1	1	01	01	H7220_009_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H7220	009	1	1	01	01	H7220_009_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H7220	009	1	1	01	01	H7220_009_1	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H7220	009	1	1	01	01	H7220_009_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H7220	009	1	1	01	01	H7220_009_1	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H7220	009	2	1	01	01	H7220_009_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H7220	009	2	1	01	01	H7220_009_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H7220	009	2	1	01	01	H7220_009_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H7220	009	2	1	01	01	H7220_009_2	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H7220	009	2	1	01	01	H7220_009_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H7220	009	2	1	01	01	H7220_009_2	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H7220	009	3	1	01	01	H7220_009_3	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H7220	009	3	1	01	01	H7220_009_3	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H7220	009	3	1	01	01	H7220_009_3	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H7220	009	3	1	01	01	H7220_009_3	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H7220	009	3	1	01	01	H7220_009_3	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H7220	009	3	1	01	01	H7220_009_3	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H7245	001	0	1	01	01	H7245_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7245	001	0	1	01	01	H7245_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7245	001	0	1	01	01	H7245_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7245	001	0	1	01	01	H7245_001_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7245	001	0	1	01	01	H7245_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7245	002	0	1	01	01	H7245_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7245	002	0	1	01	01	H7245_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7245	002	0	1	01	01	H7245_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7245	002	0	1	01	01	H7245_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7245	002	0	1	01	01	H7245_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7245	003	0	1	01	01	H7245_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7245	003	0	1	01	01	H7245_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7245	003	0	1	01	01	H7245_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7245	003	0	1	01	01	H7245_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7245	003	0	1	01	01	H7245_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7245	005	0	1	01	01	H7245_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7245	005	0	1	01	01	H7245_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7245	005	0	1	01	01	H7245_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7245	005	0	1	01	01	H7245_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7245	005	0	1	01	01	H7245_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7245	006	0	1	01	01	H7245_006_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7245	006	0	1	01	01	H7245_006_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7245	006	0	1	01	01	H7245_006_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7245	006	0	1	01	01	H7245_006_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7245	006	0	1	01	01	H7245_006_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7245	008	0	1	01	01	H7245_008_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7245	008	0	1	01	01	H7245_008_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7245	008	0	1	01	01	H7245_008_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7245	008	0	1	01	01	H7245_008_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7245	008	0	1	01	01	H7245_008_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7273	001	0	1	04	01	H7273_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H7273	001	0	1	04	01	H7273_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H7273	001	0	1	04	01	H7273_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H7273	001	0	1	04	01	H7273_001_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H7273	001	0	1	04	01	H7273_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H7273	001	0	1	04	01	H7273_001_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H7273	002	0	1	04	01	H7273_002_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H7273	002	0	1	04	01	H7273_002_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	01	1						
H7273	002	0	1	04	01	H7273_002_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	10	1						
H7273	002	0	1	04	01	H7273_002_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	10	1						
H7273	002	0	1	04	01	H7273_002_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H7273	002	0	1	04	01	H7273_002_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H7284	001	0	1	04	01	H7284_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7284	001	0	1	04	01	H7284_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7284	001	0	1	04	01	H7284_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7284	001	0	1	04	01	H7284_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7284	001	0	1	04	01	H7284_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7284	002	0	1	04	01	H7284_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7284	002	0	1	04	01	H7284_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7284	002	0	1	04	01	H7284_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7284	002	0	1	04	01	H7284_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7284	002	0	1	04	01	H7284_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7284	003	0	1	04	01	H7284_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7284	003	0	1	04	01	H7284_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7284	003	0	1	04	01	H7284_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7284	003	0	1	04	01	H7284_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7284	003	0	1	04	01	H7284_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7301	002	0	1	04	01	H7301_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7301	002	0	1	04	01	H7301_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7301	002	0	1	04	01	H7301_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7301	002	0	1	04	01	H7301_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7301	002	0	1	04	01	H7301_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7301	006	0	1	04	01	H7301_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7301	006	0	1	04	01	H7301_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7301	006	0	1	04	01	H7301_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7301	006	0	1	04	01	H7301_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7301	006	0	1	04	01	H7301_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7301	007	0	1	04	01	H7301_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7301	007	0	1	04	01	H7301_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7301	007	0	1	04	01	H7301_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7301	007	0	1	04	01	H7301_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7301	007	0	1	04	01	H7301_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7301	009	0	1	04	01	H7301_009_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7301	009	0	1	04	01	H7301_009_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7301	009	0	1	04	01	H7301_009_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7301	009	0	1	04	01	H7301_009_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7301	009	0	1	04	01	H7301_009_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7322	001	0	1	01	01	H7322_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7322	001	0	1	01	01	H7322_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7322	001	0	1	01	01	H7322_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7322	001	0	1	01	01	H7322_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7322	001	0	1	01	01	H7322_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7322	002	0	1	01	01	H7322_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7322	002	0	1	01	01	H7322_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7322	002	0	1	01	01	H7322_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7322	002	0	1	01	01	H7322_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7322	002	0	1	01	01	H7322_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7323	001	0	1	04	01	H7323_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7323	001	0	1	04	01	H7323_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7323	001	0	1	04	01	H7323_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7323	001	0	1	04	01	H7323_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7323	001	0	1	04	01	H7323_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7323	002	0	1	04	01	H7323_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7323	002	0	1	04	01	H7323_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7323	002	0	1	04	01	H7323_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7323	002	0	1	04	01	H7323_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7323	002	0	1	04	01	H7323_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7323	003	0	1	04	01	H7323_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7323	003	0	1	04	01	H7323_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7323	003	0	1	04	01	H7323_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7323	003	0	1	04	01	H7323_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7323	003	0	1	04	01	H7323_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7323	004	0	1	04	01	H7323_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7323	004	0	1	04	01	H7323_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7323	004	0	1	04	01	H7323_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7323	004	0	1	04	01	H7323_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7323	004	0	1	04	01	H7323_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7323	005	0	1	04	01	H7323_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7323	005	0	1	04	01	H7323_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7323	005	0	1	04	01	H7323_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7323	005	0	1	04	01	H7323_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7323	005	0	1	04	01	H7323_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7323	006	0	1	04	01	H7323_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7323	006	0	1	04	01	H7323_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7323	006	0	1	04	01	H7323_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7323	006	0	1	04	01	H7323_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7323	006	0	1	04	01	H7323_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7326	001	0	1	04	01	H7326_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7326	001	0	1	04	01	H7326_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7326	001	0	1	04	01	H7326_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7326	001	0	1	04	01	H7326_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7326	001	0	1	04	01	H7326_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7326	002	0	1	04	01	H7326_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7326	002	0	1	04	01	H7326_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7326	002	0	1	04	01	H7326_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7326	002	0	1	04	01	H7326_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7326	002	0	1	04	01	H7326_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7326	003	0	1	04	01	H7326_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7326	003	0	1	04	01	H7326_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7326	003	0	1	04	01	H7326_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7326	003	0	1	04	01	H7326_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7326	003	0	1	04	01	H7326_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7326	004	0	1	04	01	H7326_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7326	004	0	1	04	01	H7326_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7326	004	0	1	04	01	H7326_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7326	004	0	1	04	01	H7326_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7326	004	0	1	04	01	H7326_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7330	001	0	1	01	01	H7330_001_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H7330	001	0	1	01	01	H7330_001_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H7330	001	0	1	01	01	H7330_001_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H7330	001	0	1	01	01	H7330_001_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H7330	001	0	1	01	01	H7330_001_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H7330	001	0	1	01	01	H7330_001_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H7330	002	0	1	02	01	H7330_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	01	1						
H7330	002	0	1	02	01	H7330_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H7330	002	0	1	02	01	H7330_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H7330	002	0	1	02	01	H7330_002_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H7330	002	0	1	02	01	H7330_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H7330	002	0	1	02	01	H7330_002_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	01	1						
H7399	001	0	1	01	01	H7399_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7399	001	0	1	01	01	H7399_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7399	001	0	1	01	01	H7399_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7399	001	0	1	01	01	H7399_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7399	001	0	1	01	01	H7399_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7399	001	0	1	01	01	H7399_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7399	002	0	1	01	01	H7399_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7399	002	0	1	01	01	H7399_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7399	002	0	1	01	01	H7399_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7399	002	0	1	01	01	H7399_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7399	002	0	1	01	01	H7399_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7399	002	0	1	01	01	H7399_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7404	001	0	1	04	01	H7404_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	001	0	1	04	01	H7404_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	001	0	1	04	01	H7404_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	001	0	1	04	01	H7404_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	001	0	1	04	01	H7404_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7404	002	0	1	04	01	H7404_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	002	0	1	04	01	H7404_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	002	0	1	04	01	H7404_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	002	0	1	04	01	H7404_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	002	0	1	04	01	H7404_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7404	005	0	1	04	01	H7404_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	005	0	1	04	01	H7404_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	005	0	1	04	01	H7404_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	005	0	1	04	01	H7404_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	005	0	1	04	01	H7404_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7404	006	0	1	04	01	H7404_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	006	0	1	04	01	H7404_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	006	0	1	04	01	H7404_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	006	0	1	04	01	H7404_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	006	0	1	04	01	H7404_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7404	011	0	1	04	01	H7404_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	011	0	1	04	01	H7404_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	011	0	1	04	01	H7404_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	011	0	1	04	01	H7404_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	011	0	1	04	01	H7404_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7404	012	0	1	04	01	H7404_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	012	0	1	04	01	H7404_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	012	0	1	04	01	H7404_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	012	0	1	04	01	H7404_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	012	0	1	04	01	H7404_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7404	014	0	1	04	01	H7404_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	014	0	1	04	01	H7404_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	014	0	1	04	01	H7404_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	014	0	1	04	01	H7404_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	014	0	1	04	01	H7404_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7404	018	0	1	04	01	H7404_018_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	018	0	1	04	01	H7404_018_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	018	0	1	04	01	H7404_018_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	018	0	1	04	01	H7404_018_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	018	0	1	04	01	H7404_018_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7404	020	0	1	04	01	H7404_020_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	020	0	1	04	01	H7404_020_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	020	0	1	04	01	H7404_020_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	020	0	1	04	01	H7404_020_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	020	0	1	04	01	H7404_020_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7404	021	0	1	04	01	H7404_021_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7404	021	0	1	04	01	H7404_021_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7404	021	0	1	04	01	H7404_021_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7404	021	0	1	04	01	H7404_021_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7404	021	0	1	04	01	H7404_021_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7409	001	0	1	01	01	H7409_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7409	001	0	1	01	01	H7409_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7409	001	0	1	01	01	H7409_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7409	001	0	1	01	01	H7409_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7409	001	0	1	01	01	H7409_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7409	001	0	1	01	01	H7409_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H7419	001	0	1	48	05	H7419_001_0	2	$0 Drugs	4	$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	11					1	0.00	0.00
H7419	001	0	1	48	05	H7419_001_0	2	Generic Drugs	4	$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	01					1	0.00	0.00
H7419	001	0	1	48	05	H7419_001_0	2	Brand Drugs	4	$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	10					1	0.00	0.00
H7419	001	0	1	48	05	H7419_001_0	2	Non-Medicare Rx/OTC Drugs	4	$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	4	2	11					2	0.00	0.00
H7445	005	0	1	01	01	H7445_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7445	005	0	1	01	01	H7445_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H7445	005	0	1	01	01	H7445_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7445	005	0	1	01	01	H7445_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7445	005	0	1	01	01	H7445_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7511	002	0	1	01	01	H7511_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H7511	002	0	1	01	01	H7511_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H7511	002	0	1	01	01	H7511_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H7511	002	0	1	01	01	H7511_002_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H7511	002	0	1	01	01	H7511_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H7518	001	0	1	04	01	H7518_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7518	001	0	1	04	01	H7518_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7518	001	0	1	04	01	H7518_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7518	001	0	1	04	01	H7518_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7518	001	0	1	04	01	H7518_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7518	003	0	1	04	01	H7518_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7518	003	0	1	04	01	H7518_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7518	003	0	1	04	01	H7518_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7518	003	0	1	04	01	H7518_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7518	003	0	1	04	01	H7518_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7594	001	0	1	01	01	H7594_001_0	15	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7594	001	0	1	01	01	H7594_001_0	15	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7594	001	0	1	01	01	H7594_001_0	15	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H7594	001	0	1	01	01	H7594_001_0	15	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7594	001	0	1	01	01	H7594_001_0	15	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7594	001	0	1	01	01	H7594_001_0	15	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7594	002	0	1	01	01	H7594_002_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7594	002	0	1	01	01	H7594_002_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7594	002	0	1	01	01	H7594_002_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H7594	002	0	1	01	01	H7594_002_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7594	002	0	1	01	01	H7594_002_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7594	002	0	1	01	01	H7594_002_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7594	003	0	1	01	01	H7594_003_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7594	003	0	1	01	01	H7594_003_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7594	003	0	1	01	01	H7594_003_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H7594	003	0	1	01	01	H7594_003_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7594	003	0	1	01	01	H7594_003_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7594	003	0	1	01	01	H7594_003_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7594	004	0	1	01	01	H7594_004_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7594	004	0	1	01	01	H7594_004_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7594	004	0	1	01	01	H7594_004_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	3						
H7594	004	0	1	01	01	H7594_004_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7594	004	0	1	01	01	H7594_004_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7594	004	0	1	01	01	H7594_004_0	10	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7598	001	0	1	01	01	H7598_001_0	5	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7598	001	0	1	01	01	H7598_001_0	5	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7598	001	0	1	01	01	H7598_001_0	5	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H7598	001	0	1	01	01	H7598_001_0	5	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H7598	001	0	1	01	01	H7598_001_0	5	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7607	002	1	1	01	01	H7607_002_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H7607	002	1	1	01	01	H7607_002_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H7607	002	1	1	01	01	H7607_002_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H7607	002	1	1	01	01	H7607_002_1	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	11	1						
H7607	002	1	1	01	01	H7607_002_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H7607	002	1	1	01	01	H7607_002_1	8	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H7607	002	2	1	01	01	H7607_002_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H7607	002	2	1	01	01	H7607_002_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H7607	002	2	1	01	01	H7607_002_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H7607	002	2	1	01	01	H7607_002_2	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	11	1						
H7607	002	2	1	01	01	H7607_002_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H7607	002	2	1	01	01	H7607_002_2	8	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H7607	002	3	1	01	01	H7607_002_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H7607	002	3	1	01	01	H7607_002_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H7607	002	3	1	01	01	H7607_002_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H7607	002	3	1	01	01	H7607_002_3	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	11	1						
H7607	002	3	1	01	01	H7607_002_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H7607	002	3	1	01	01	H7607_002_3	8	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H7607	003	1	1	01	01	H7607_003_1	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H7607	003	1	1	01	01	H7607_003_1	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H7607	003	1	1	01	01	H7607_003_1	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H7607	003	1	1	01	01	H7607_003_1	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	11	1						
H7607	003	1	1	01	01	H7607_003_1	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H7607	003	1	1	01	01	H7607_003_1	8	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H7607	003	2	1	01	01	H7607_003_2	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H7607	003	2	1	01	01	H7607_003_2	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H7607	003	2	1	01	01	H7607_003_2	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H7607	003	2	1	01	01	H7607_003_2	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	11	1						
H7607	003	2	1	01	01	H7607_003_2	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H7607	003	2	1	01	01	H7607_003_2	8	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H7607	003	3	1	01	01	H7607_003_3	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	1	2	01	1						
H7607	003	3	1	01	01	H7607_003_3	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	2	2	01	1						
H7607	003	3	1	01	01	H7607_003_3	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	3	2	10	1						
H7607	003	3	1	01	01	H7607_003_3	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	4	2	11	1						
H7607	003	3	1	01	01	H7607_003_3	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	5	2	11	1						
H7607	003	3	1	01	01	H7607_003_3	8	Supplemental Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs	6	2	11	2						
H7621	001	0	1	01	01	H7621_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7621	001	0	1	01	01	H7621_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7621	001	0	1	01	01	H7621_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7621	001	0	1	01	01	H7621_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7621	001	0	1	01	01	H7621_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7621	002	0	1	01	01	H7621_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7621	002	0	1	01	01	H7621_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7621	002	0	1	01	01	H7621_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7621	002	0	1	01	01	H7621_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7621	002	0	1	01	01	H7621_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7621	003	0	1	01	01	H7621_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H7621	003	0	1	01	01	H7621_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7621	003	0	1	01	01	H7621_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7621	003	0	1	01	01	H7621_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7621	003	0	1	01	01	H7621_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7646	001	0	1	02	01	H7646_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7646	001	0	1	02	01	H7646_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7646	001	0	1	02	01	H7646_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7646	001	0	1	02	01	H7646_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7646	001	0	1	02	01	H7646_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7646	002	0	1	02	01	H7646_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7646	002	0	1	02	01	H7646_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7646	002	0	1	02	01	H7646_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7646	002	0	1	02	01	H7646_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7646	002	0	1	02	01	H7646_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7646	003	0	1	02	01	H7646_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7646	003	0	1	02	01	H7646_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7646	003	0	1	02	01	H7646_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7646	003	0	1	02	01	H7646_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7646	003	0	1	02	01	H7646_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7646	004	0	1	02	01	H7646_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7646	004	0	1	02	01	H7646_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7646	004	0	1	02	01	H7646_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7646	004	0	1	02	01	H7646_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7646	004	0	1	02	01	H7646_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7646	005	0	1	02	01	H7646_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7646	005	0	1	02	01	H7646_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7646	005	0	1	02	01	H7646_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7646	005	0	1	02	01	H7646_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7646	005	0	1	02	01	H7646_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7646	006	0	1	02	01	H7646_006_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7646	006	0	1	02	01	H7646_006_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7646	006	0	1	02	01	H7646_006_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7646	006	0	1	02	01	H7646_006_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7646	006	0	1	02	01	H7646_006_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7678	001	0	1	01	01	H7678_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7678	001	0	1	01	01	H7678_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7678	001	0	1	01	01	H7678_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7678	001	0	1	01	01	H7678_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7678	001	0	1	01	01	H7678_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7680	001	0	1	01	01	H7680_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H7680	001	0	1	01	01	H7680_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7680	001	0	1	01	01	H7680_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7680	001	0	1	01	01	H7680_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7680	001	0	1	01	01	H7680_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7680	001	0	1	01	01	H7680_001_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H7680	002	0	1	01	01	H7680_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H7680	002	0	1	01	01	H7680_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7680	002	0	1	01	01	H7680_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7680	002	0	1	01	01	H7680_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7680	002	0	1	01	01	H7680_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7680	002	0	1	01	01	H7680_002_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H7728	002	0	1	04	01	H7728_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H7728	002	0	1	04	01	H7728_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7728	002	0	1	04	01	H7728_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7728	002	0	1	04	01	H7728_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7728	002	0	1	04	01	H7728_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7728	002	0	1	04	01	H7728_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H7728	004	1	1	04	01	H7728_004_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7728	004	1	1	04	01	H7728_004_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7728	004	1	1	04	01	H7728_004_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7728	004	1	1	04	01	H7728_004_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7728	004	1	1	04	01	H7728_004_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7728	004	1	1	04	01	H7728_004_1	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H7728	004	2	1	04	01	H7728_004_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7728	004	2	1	04	01	H7728_004_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7728	004	2	1	04	01	H7728_004_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7728	004	2	1	04	01	H7728_004_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7728	004	2	1	04	01	H7728_004_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7728	004	2	1	04	01	H7728_004_2	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H7728	005	0	1	04	01	H7728_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7728	005	0	1	04	01	H7728_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7728	005	0	1	04	01	H7728_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7728	005	0	1	04	01	H7728_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7728	005	0	1	04	01	H7728_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7728	005	0	1	04	01	H7728_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H7728	006	0	1	04	01	H7728_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7728	006	0	1	04	01	H7728_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7728	006	0	1	04	01	H7728_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7728	006	0	1	04	01	H7728_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7728	006	0	1	04	01	H7728_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7728	006	0	1	04	01	H7728_006_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H7728	009	0	1	04	01	H7728_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7728	009	0	1	04	01	H7728_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7728	009	0	1	04	01	H7728_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7728	009	0	1	04	01	H7728_009_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7728	009	0	1	04	01	H7728_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7728	009	0	1	04	01	H7728_009_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H7787	001	0	1	04	01	H7787_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7787	001	0	1	04	01	H7787_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7787	001	0	1	04	01	H7787_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7787	001	0	1	04	01	H7787_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7787	001	0	1	04	01	H7787_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7833	001	0	1	48	05	H7833_001_0	4	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H7833	001	0	1	48	05	H7833_001_0	4	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H7833	001	0	1	48	05	H7833_001_0	4	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H7844	001	0	1	48	05	H7844_001_0	5	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H7844	001	0	1	48	05	H7844_001_0	5	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H7844	001	0	1	48	05	H7844_001_0	5	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H7849	001	0	1	04	01	H7849_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	001	0	1	04	01	H7849_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	001	0	1	04	01	H7849_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	001	0	1	04	01	H7849_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	001	0	1	04	01	H7849_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	002	0	1	04	01	H7849_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	002	0	1	04	01	H7849_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	002	0	1	04	01	H7849_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	002	0	1	04	01	H7849_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	002	0	1	04	01	H7849_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	003	0	1	04	01	H7849_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	003	0	1	04	01	H7849_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	003	0	1	04	01	H7849_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	003	0	1	04	01	H7849_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	003	0	1	04	01	H7849_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	006	0	1	04	01	H7849_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	006	0	1	04	01	H7849_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	006	0	1	04	01	H7849_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	006	0	1	04	01	H7849_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	006	0	1	04	01	H7849_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	007	0	1	04	01	H7849_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	007	0	1	04	01	H7849_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	007	0	1	04	01	H7849_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	007	0	1	04	01	H7849_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	007	0	1	04	01	H7849_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	008	0	1	04	01	H7849_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	008	0	1	04	01	H7849_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	008	0	1	04	01	H7849_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	008	0	1	04	01	H7849_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	008	0	1	04	01	H7849_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	009	0	1	04	01	H7849_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	009	0	1	04	01	H7849_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	009	0	1	04	01	H7849_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	009	0	1	04	01	H7849_009_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	009	0	1	04	01	H7849_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	010	0	1	04	01	H7849_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	010	0	1	04	01	H7849_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	010	0	1	04	01	H7849_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	010	0	1	04	01	H7849_010_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	010	0	1	04	01	H7849_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	011	0	1	04	01	H7849_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	011	0	1	04	01	H7849_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	011	0	1	04	01	H7849_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	011	0	1	04	01	H7849_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	011	0	1	04	01	H7849_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	012	0	1	04	01	H7849_012_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	012	0	1	04	01	H7849_012_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	012	0	1	04	01	H7849_012_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	012	0	1	04	01	H7849_012_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	012	0	1	04	01	H7849_012_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	013	0	1	04	01	H7849_013_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	013	0	1	04	01	H7849_013_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	013	0	1	04	01	H7849_013_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	013	0	1	04	01	H7849_013_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	013	0	1	04	01	H7849_013_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	014	0	1	04	01	H7849_014_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H7849	014	0	1	04	01	H7849_014_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	014	0	1	04	01	H7849_014_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	014	0	1	04	01	H7849_014_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	014	0	1	04	01	H7849_014_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	015	0	1	04	01	H7849_015_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	015	0	1	04	01	H7849_015_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	015	0	1	04	01	H7849_015_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	015	0	1	04	01	H7849_015_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	015	0	1	04	01	H7849_015_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	016	0	1	04	01	H7849_016_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	016	0	1	04	01	H7849_016_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	016	0	1	04	01	H7849_016_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	016	0	1	04	01	H7849_016_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	016	0	1	04	01	H7849_016_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	017	0	1	04	01	H7849_017_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	017	0	1	04	01	H7849_017_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	017	0	1	04	01	H7849_017_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	017	0	1	04	01	H7849_017_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	017	0	1	04	01	H7849_017_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	018	0	1	04	01	H7849_018_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	018	0	1	04	01	H7849_018_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	018	0	1	04	01	H7849_018_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	018	0	1	04	01	H7849_018_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	018	0	1	04	01	H7849_018_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	019	0	1	04	01	H7849_019_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	019	0	1	04	01	H7849_019_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	019	0	1	04	01	H7849_019_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	019	0	1	04	01	H7849_019_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	019	0	1	04	01	H7849_019_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	020	0	1	04	01	H7849_020_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	020	0	1	04	01	H7849_020_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	020	0	1	04	01	H7849_020_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	020	0	1	04	01	H7849_020_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	020	0	1	04	01	H7849_020_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	021	0	1	04	01	H7849_021_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	021	0	1	04	01	H7849_021_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	021	0	1	04	01	H7849_021_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	021	0	1	04	01	H7849_021_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	021	0	1	04	01	H7849_021_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	022	0	1	04	01	H7849_022_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	022	0	1	04	01	H7849_022_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	022	0	1	04	01	H7849_022_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	022	0	1	04	01	H7849_022_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	022	0	1	04	01	H7849_022_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	023	0	1	04	01	H7849_023_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	023	0	1	04	01	H7849_023_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	023	0	1	04	01	H7849_023_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	023	0	1	04	01	H7849_023_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	023	0	1	04	01	H7849_023_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	024	0	1	04	01	H7849_024_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	024	0	1	04	01	H7849_024_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	024	0	1	04	01	H7849_024_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	024	0	1	04	01	H7849_024_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	024	0	1	04	01	H7849_024_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	026	0	1	04	01	H7849_026_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	026	0	1	04	01	H7849_026_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	026	0	1	04	01	H7849_026_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	026	0	1	04	01	H7849_026_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	026	0	1	04	01	H7849_026_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	027	0	1	04	01	H7849_027_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	027	0	1	04	01	H7849_027_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	027	0	1	04	01	H7849_027_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	027	0	1	04	01	H7849_027_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	027	0	1	04	01	H7849_027_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	028	0	1	04	01	H7849_028_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	028	0	1	04	01	H7849_028_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	028	0	1	04	01	H7849_028_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	028	0	1	04	01	H7849_028_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	028	0	1	04	01	H7849_028_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	029	0	1	04	01	H7849_029_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	029	0	1	04	01	H7849_029_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	029	0	1	04	01	H7849_029_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	029	0	1	04	01	H7849_029_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	029	0	1	04	01	H7849_029_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	030	0	1	04	01	H7849_030_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	030	0	1	04	01	H7849_030_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	030	0	1	04	01	H7849_030_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	030	0	1	04	01	H7849_030_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	030	0	1	04	01	H7849_030_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	031	0	1	04	01	H7849_031_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	031	0	1	04	01	H7849_031_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	031	0	1	04	01	H7849_031_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	031	0	1	04	01	H7849_031_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	031	0	1	04	01	H7849_031_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	032	0	1	04	01	H7849_032_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	032	0	1	04	01	H7849_032_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	032	0	1	04	01	H7849_032_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	032	0	1	04	01	H7849_032_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	032	0	1	04	01	H7849_032_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	033	0	1	04	01	H7849_033_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	033	0	1	04	01	H7849_033_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	033	0	1	04	01	H7849_033_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	033	0	1	04	01	H7849_033_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	033	0	1	04	01	H7849_033_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	034	0	1	04	01	H7849_034_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	034	0	1	04	01	H7849_034_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	034	0	1	04	01	H7849_034_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	034	0	1	04	01	H7849_034_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	034	0	1	04	01	H7849_034_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	035	0	1	04	01	H7849_035_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	035	0	1	04	01	H7849_035_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	035	0	1	04	01	H7849_035_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	035	0	1	04	01	H7849_035_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	035	0	1	04	01	H7849_035_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	036	0	1	04	01	H7849_036_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	036	0	1	04	01	H7849_036_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	036	0	1	04	01	H7849_036_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	036	0	1	04	01	H7849_036_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	036	0	1	04	01	H7849_036_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	037	0	1	04	01	H7849_037_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	037	0	1	04	01	H7849_037_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	037	0	1	04	01	H7849_037_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	037	0	1	04	01	H7849_037_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	037	0	1	04	01	H7849_037_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	038	0	1	04	01	H7849_038_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	038	0	1	04	01	H7849_038_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	038	0	1	04	01	H7849_038_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	038	0	1	04	01	H7849_038_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	038	0	1	04	01	H7849_038_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	039	0	1	04	01	H7849_039_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	039	0	1	04	01	H7849_039_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	039	0	1	04	01	H7849_039_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	039	0	1	04	01	H7849_039_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	039	0	1	04	01	H7849_039_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	040	0	1	04	01	H7849_040_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	040	0	1	04	01	H7849_040_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	040	0	1	04	01	H7849_040_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	040	0	1	04	01	H7849_040_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	040	0	1	04	01	H7849_040_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	041	0	1	04	01	H7849_041_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	041	0	1	04	01	H7849_041_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	041	0	1	04	01	H7849_041_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	041	0	1	04	01	H7849_041_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	041	0	1	04	01	H7849_041_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	042	0	1	04	01	H7849_042_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	042	0	1	04	01	H7849_042_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	042	0	1	04	01	H7849_042_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	042	0	1	04	01	H7849_042_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	042	0	1	04	01	H7849_042_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7849	043	0	1	04	01	H7849_043_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7849	043	0	1	04	01	H7849_043_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7849	043	0	1	04	01	H7849_043_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7849	043	0	1	04	01	H7849_043_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7849	043	0	1	04	01	H7849_043_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7853	001	0	1	01	01	H7853_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7853	001	0	1	01	01	H7853_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7853	001	0	1	01	01	H7853_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7853	001	0	1	01	01	H7853_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7853	001	0	1	01	01	H7853_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7853	001	0	1	01	01	H7853_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H7853	002	0	1	01	01	H7853_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7853	002	0	1	01	01	H7853_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7853	002	0	1	01	01	H7853_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7853	002	0	1	01	01	H7853_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7853	002	0	1	01	01	H7853_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7853	002	0	1	01	01	H7853_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H7853	005	0	1	01	01	H7853_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7853	005	0	1	01	01	H7853_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7853	005	0	1	01	01	H7853_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7853	005	0	1	01	01	H7853_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7853	005	0	1	01	01	H7853_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7853	005	0	1	01	01	H7853_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H7853	007	0	1	01	01	H7853_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7853	007	0	1	01	01	H7853_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7853	007	0	1	01	01	H7853_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7853	007	0	1	01	01	H7853_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7853	007	0	1	01	01	H7853_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7853	007	0	1	01	01	H7853_007_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H7853	008	0	1	01	01	H7853_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H7853	008	0	1	01	01	H7853_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H7853	008	0	1	01	01	H7853_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7853	008	0	1	01	01	H7853_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7853	008	0	1	01	01	H7853_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7853	008	0	1	01	01	H7853_008_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H7885	001	0	1	48	05	H7885_001_0	4	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H7885	001	0	1	48	05	H7885_001_0	4	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H7885	001	0	1	48	05	H7885_001_0	4	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H7890	001	0	1	48	05	H7890_001_0	6	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	2	01					1	0.00	0.00
H7890	001	0	1	48	05	H7890_001_0	6	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	2	10					1	0.00	0.00
H7890	001	0	1	48	05	H7890_001_0	6	Non-Medicare Rx Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	3	2	11					2	0.00	0.00
H7890	001	0	1	48	05	H7890_001_0	6	Non-Medicare OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	4	2	11					2	0.00	0.00
H7917	009	0	1	04	01	H7917_009_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	009	0	1	04	01	H7917_009_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	009	0	1	04	01	H7917_009_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	009	0	1	04	01	H7917_009_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	009	0	1	04	01	H7917_009_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	010	0	1	04	01	H7917_010_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	010	0	1	04	01	H7917_010_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	010	0	1	04	01	H7917_010_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	010	0	1	04	01	H7917_010_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	010	0	1	04	01	H7917_010_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	011	0	1	04	01	H7917_011_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	011	0	1	04	01	H7917_011_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	011	0	1	04	01	H7917_011_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	011	0	1	04	01	H7917_011_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	011	0	1	04	01	H7917_011_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	012	0	1	04	01	H7917_012_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	012	0	1	04	01	H7917_012_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	012	0	1	04	01	H7917_012_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	012	0	1	04	01	H7917_012_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	012	0	1	04	01	H7917_012_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	013	0	1	04	01	H7917_013_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	013	0	1	04	01	H7917_013_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	013	0	1	04	01	H7917_013_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	013	0	1	04	01	H7917_013_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	013	0	1	04	01	H7917_013_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	014	0	1	04	01	H7917_014_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	014	0	1	04	01	H7917_014_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	014	0	1	04	01	H7917_014_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	014	0	1	04	01	H7917_014_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	014	0	1	04	01	H7917_014_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	015	0	1	04	01	H7917_015_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	015	0	1	04	01	H7917_015_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	015	0	1	04	01	H7917_015_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	015	0	1	04	01	H7917_015_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	015	0	1	04	01	H7917_015_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	030	0	1	04	01	H7917_030_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	030	0	1	04	01	H7917_030_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	030	0	1	04	01	H7917_030_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	030	0	1	04	01	H7917_030_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	030	0	1	04	01	H7917_030_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	031	0	1	04	01	H7917_031_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	031	0	1	04	01	H7917_031_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	031	0	1	04	01	H7917_031_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	031	0	1	04	01	H7917_031_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	031	0	1	04	01	H7917_031_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	032	0	1	04	01	H7917_032_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	032	0	1	04	01	H7917_032_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	032	0	1	04	01	H7917_032_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	032	0	1	04	01	H7917_032_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	032	0	1	04	01	H7917_032_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	033	0	1	04	01	H7917_033_0	11	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	033	0	1	04	01	H7917_033_0	11	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	033	0	1	04	01	H7917_033_0	11	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	033	0	1	04	01	H7917_033_0	11	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	033	0	1	04	01	H7917_033_0	11	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	034	0	1	04	01	H7917_034_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	034	0	1	04	01	H7917_034_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	034	0	1	04	01	H7917_034_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	034	0	1	04	01	H7917_034_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	034	0	1	04	01	H7917_034_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	035	0	1	04	01	H7917_035_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	035	0	1	04	01	H7917_035_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	035	0	1	04	01	H7917_035_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	035	0	1	04	01	H7917_035_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	035	0	1	04	01	H7917_035_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	036	0	1	04	01	H7917_036_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	036	0	1	04	01	H7917_036_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	036	0	1	04	01	H7917_036_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	036	0	1	04	01	H7917_036_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	036	0	1	04	01	H7917_036_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7917	037	0	1	04	01	H7917_037_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7917	037	0	1	04	01	H7917_037_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H7917	037	0	1	04	01	H7917_037_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7917	037	0	1	04	01	H7917_037_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7917	037	0	1	04	01	H7917_037_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7925	001	0	1	01	01	H7925_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7925	001	0	1	01	01	H7925_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7925	001	0	1	01	01	H7925_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7925	001	0	1	01	01	H7925_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7925	001	0	1	01	01	H7925_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7925	001	0	1	01	01	H7925_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7925	002	0	1	01	01	H7925_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H7925	002	0	1	01	01	H7925_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H7925	002	0	1	01	01	H7925_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H7925	002	0	1	01	01	H7925_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H7925	002	0	1	01	01	H7925_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H7925	002	0	1	01	01	H7925_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H7971	003	0	1	04	01	H7971_003_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H7971	003	0	1	04	01	H7971_003_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H7971	003	0	1	04	01	H7971_003_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7971	003	0	1	04	01	H7971_003_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7971	003	0	1	04	01	H7971_003_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7993	001	0	1	01	01	H7993_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7993	001	0	1	01	01	H7993_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7993	001	0	1	01	01	H7993_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7993	001	0	1	01	01	H7993_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7993	001	0	1	01	01	H7993_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7993	002	0	1	01	01	H7993_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7993	002	0	1	01	01	H7993_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7993	002	0	1	01	01	H7993_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7993	002	0	1	01	01	H7993_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7993	002	0	1	01	01	H7993_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7993	003	0	1	01	01	H7993_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7993	003	0	1	01	01	H7993_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7993	003	0	1	01	01	H7993_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7993	003	0	1	01	01	H7993_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7993	003	0	1	01	01	H7993_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H7993	004	0	1	01	01	H7993_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H7993	004	0	1	01	01	H7993_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H7993	004	0	1	01	01	H7993_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H7993	004	0	1	01	01	H7993_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H7993	004	0	1	01	01	H7993_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8003	001	0	1	04	01	H8003_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8003	001	0	1	04	01	H8003_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8003	001	0	1	04	01	H8003_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8003	001	0	1	04	01	H8003_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8003	001	0	1	04	01	H8003_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8003	002	0	1	04	01	H8003_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8003	002	0	1	04	01	H8003_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8003	002	0	1	04	01	H8003_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8003	002	0	1	04	01	H8003_002_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8003	002	0	1	04	01	H8003_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8003	003	0	1	04	01	H8003_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8003	003	0	1	04	01	H8003_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8003	003	0	1	04	01	H8003_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8003	003	0	1	04	01	H8003_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8003	003	0	1	04	01	H8003_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8003	004	0	1	04	01	H8003_004_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8003	004	0	1	04	01	H8003_004_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8003	004	0	1	04	01	H8003_004_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8003	004	0	1	04	01	H8003_004_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8003	004	0	1	04	01	H8003_004_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8003	005	0	1	04	01	H8003_005_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8003	005	0	1	04	01	H8003_005_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8003	005	0	1	04	01	H8003_005_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8003	005	0	1	04	01	H8003_005_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8003	005	0	1	04	01	H8003_005_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8010	002	0	1	01	01	H8010_002_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8010	002	0	1	01	01	H8010_002_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8010	002	0	1	01	01	H8010_002_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8010	002	0	1	01	01	H8010_002_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8010	002	0	1	01	01	H8010_002_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8010	003	0	1	01	01	H8010_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8010	003	0	1	01	01	H8010_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8010	003	0	1	01	01	H8010_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8010	003	0	1	01	01	H8010_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8010	003	0	1	01	01	H8010_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8010	005	0	1	01	01	H8010_005_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8010	005	0	1	01	01	H8010_005_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8010	005	0	1	01	01	H8010_005_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8010	005	0	1	01	01	H8010_005_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8010	005	0	1	01	01	H8010_005_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8010	008	0	1	01	01	H8010_008_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8010	008	0	1	01	01	H8010_008_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8010	008	0	1	01	01	H8010_008_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8010	008	0	1	01	01	H8010_008_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8010	008	0	1	01	01	H8010_008_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8016	001	0	1	48	05	H8016_001_0	5	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H8016	001	0	1	48	05	H8016_001_0	5	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H8016	001	0	1	48	05	H8016_001_0	5	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H8019	001	0	1	01	01	H8019_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H8019	001	0	1	01	01	H8019_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H8019	001	0	1	01	01	H8019_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	11	1						
H8019	001	0	1	01	01	H8019_001_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H8019	001	0	1	01	01	H8019_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H8019	001	0	1	01	01	H8019_001_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H8019	002	0	1	02	01	H8019_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H8019	002	0	1	02	01	H8019_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H8019	002	0	1	02	01	H8019_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	11	1						
H8019	002	0	1	02	01	H8019_002_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H8019	002	0	1	02	01	H8019_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H8019	002	0	1	02	01	H8019_002_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H8019	004	0	1	01	01	H8019_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H8019	004	0	1	01	01	H8019_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H8019	004	0	1	01	01	H8019_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	11	1						
H8019	004	0	1	01	01	H8019_004_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H8019	004	0	1	01	01	H8019_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H8019	004	0	1	01	01	H8019_004_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H8026	001	0	1	48	05	H8026_001_0	2	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	11					1	0.00	0.00
H8026	001	0	1	48	05	H8026_001_0	2	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H8026	001	0	1	48	05	H8026_001_0	2	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H8046	001	0	1	48	05	H8046_001_0	4	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H8046	001	0	1	48	05	H8046_001_0	4	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H8046	001	0	1	48	05	H8046_001_0	4	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H8064	002	0	1	04	01	H8064_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8064	002	0	1	04	01	H8064_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8064	002	0	1	04	01	H8064_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8064	002	0	1	04	01	H8064_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8064	002	0	1	04	01	H8064_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8064	004	0	1	04	01	H8064_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8064	004	0	1	04	01	H8064_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8064	004	0	1	04	01	H8064_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8064	004	0	1	04	01	H8064_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8064	004	0	1	04	01	H8064_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8087	001	0	1	04	01	H8087_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8087	001	0	1	04	01	H8087_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8087	001	0	1	04	01	H8087_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8087	001	0	1	04	01	H8087_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8087	001	0	1	04	01	H8087_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8087	002	0	1	04	01	H8087_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8087	002	0	1	04	01	H8087_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8087	002	0	1	04	01	H8087_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8087	002	0	1	04	01	H8087_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8087	002	0	1	04	01	H8087_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8087	003	0	1	04	01	H8087_003_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8087	003	0	1	04	01	H8087_003_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8087	003	0	1	04	01	H8087_003_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8087	003	0	1	04	01	H8087_003_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8087	003	0	1	04	01	H8087_003_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8130	001	0	1	01	01	H8130_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8130	001	0	1	01	01	H8130_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8130	001	0	1	01	01	H8130_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8130	001	0	1	01	01	H8130_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8130	001	0	1	01	01	H8130_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8133	001	0	1	01	01	H8133_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8133	001	0	1	01	01	H8133_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8133	001	0	1	01	01	H8133_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8133	001	0	1	01	01	H8133_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8133	001	0	1	01	01	H8133_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8133	003	0	1	01	01	H8133_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8133	003	0	1	01	01	H8133_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8133	003	0	1	01	01	H8133_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8133	003	0	1	01	01	H8133_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8133	003	0	1	01	01	H8133_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8133	005	0	1	01	01	H8133_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8133	005	0	1	01	01	H8133_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8133	005	0	1	01	01	H8133_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8133	005	0	1	01	01	H8133_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8133	005	0	1	01	01	H8133_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8142	001	0	1	01	01	H8142_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8142	001	0	1	01	01	H8142_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8142	001	0	1	01	01	H8142_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8142	001	0	1	01	01	H8142_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8142	001	0	1	01	01	H8142_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8142	002	0	1	01	01	H8142_002_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8142	002	0	1	01	01	H8142_002_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8142	002	0	1	01	01	H8142_002_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8142	002	0	1	01	01	H8142_002_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8142	002	0	1	01	01	H8142_002_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8142	003	0	1	01	01	H8142_003_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8142	003	0	1	01	01	H8142_003_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8142	003	0	1	01	01	H8142_003_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8142	003	0	1	01	01	H8142_003_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8142	003	0	1	01	01	H8142_003_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8142	007	0	1	01	01	H8142_007_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8142	007	0	1	01	01	H8142_007_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8142	007	0	1	01	01	H8142_007_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8142	007	0	1	01	01	H8142_007_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8142	007	0	1	01	01	H8142_007_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	004	0	1	09	04	H8145_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	004	0	1	09	04	H8145_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	004	0	1	09	04	H8145_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	004	0	1	09	04	H8145_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	004	0	1	09	04	H8145_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	006	0	1	09	04	H8145_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	006	0	1	09	04	H8145_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	006	0	1	09	04	H8145_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	006	0	1	09	04	H8145_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	006	0	1	09	04	H8145_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	008	0	1	09	04	H8145_008_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	008	0	1	09	04	H8145_008_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	008	0	1	09	04	H8145_008_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	008	0	1	09	04	H8145_008_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	008	0	1	09	04	H8145_008_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	021	0	1	09	04	H8145_021_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	021	0	1	09	04	H8145_021_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	021	0	1	09	04	H8145_021_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	021	0	1	09	04	H8145_021_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	021	0	1	09	04	H8145_021_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	032	0	1	09	04	H8145_032_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	032	0	1	09	04	H8145_032_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	032	0	1	09	04	H8145_032_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	032	0	1	09	04	H8145_032_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	032	0	1	09	04	H8145_032_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	052	0	1	09	04	H8145_052_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	052	0	1	09	04	H8145_052_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	052	0	1	09	04	H8145_052_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	052	0	1	09	04	H8145_052_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	052	0	1	09	04	H8145_052_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	061	0	1	09	04	H8145_061_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	061	0	1	09	04	H8145_061_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	061	0	1	09	04	H8145_061_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	061	0	1	09	04	H8145_061_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	061	0	1	09	04	H8145_061_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	069	0	1	09	04	H8145_069_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	069	0	1	09	04	H8145_069_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	069	0	1	09	04	H8145_069_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	069	0	1	09	04	H8145_069_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	069	0	1	09	04	H8145_069_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	075	0	1	09	04	H8145_075_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	075	0	1	09	04	H8145_075_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	075	0	1	09	04	H8145_075_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	075	0	1	09	04	H8145_075_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	075	0	1	09	04	H8145_075_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	084	0	1	09	04	H8145_084_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	084	0	1	09	04	H8145_084_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	084	0	1	09	04	H8145_084_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	084	0	1	09	04	H8145_084_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	084	0	1	09	04	H8145_084_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	089	0	1	09	04	H8145_089_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	089	0	1	09	04	H8145_089_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	089	0	1	09	04	H8145_089_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	089	0	1	09	04	H8145_089_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	089	0	1	09	04	H8145_089_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	091	0	1	09	04	H8145_091_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	091	0	1	09	04	H8145_091_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	091	0	1	09	04	H8145_091_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	091	0	1	09	04	H8145_091_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	091	0	1	09	04	H8145_091_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	122	0	1	09	04	H8145_122_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	122	0	1	09	04	H8145_122_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	122	0	1	09	04	H8145_122_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	122	0	1	09	04	H8145_122_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	122	0	1	09	04	H8145_122_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	123	0	1	09	04	H8145_123_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	123	0	1	09	04	H8145_123_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	123	0	1	09	04	H8145_123_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	123	0	1	09	04	H8145_123_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	123	0	1	09	04	H8145_123_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8145	125	0	1	09	04	H8145_125_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8145	125	0	1	09	04	H8145_125_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8145	125	0	1	09	04	H8145_125_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8145	125	0	1	09	04	H8145_125_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8145	125	0	1	09	04	H8145_125_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8173	001	0	1	01	01	H8173_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8173	001	0	1	01	01	H8173_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H8173	001	0	1	01	01	H8173_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8173	001	0	1	01	01	H8173_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8173	001	0	1	01	01	H8173_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8173	002	0	1	01	01	H8173_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8173	002	0	1	01	01	H8173_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H8173	002	0	1	01	01	H8173_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8173	002	0	1	01	01	H8173_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8173	002	0	1	01	01	H8173_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8173	003	0	1	01	01	H8173_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8173	003	0	1	01	01	H8173_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H8173	003	0	1	01	01	H8173_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8173	003	0	1	01	01	H8173_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8173	003	0	1	01	01	H8173_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8176	001	0	1	01	01	H8176_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8176	001	0	1	01	01	H8176_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8176	001	0	1	01	01	H8176_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8176	001	0	1	01	01	H8176_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8176	001	0	1	01	01	H8176_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8176	002	0	1	01	01	H8176_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8176	002	0	1	01	01	H8176_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8176	002	0	1	01	01	H8176_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8176	002	0	1	01	01	H8176_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8176	002	0	1	01	01	H8176_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8181	001	0	1	04	01	H8181_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
H8181	001	0	1	04	01	H8181_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8181	001	0	1	04	01	H8181_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8181	001	0	1	04	01	H8181_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8181	001	0	1	04	01	H8181_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8189	001	0	1	01	01	H8189_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8189	001	0	1	01	01	H8189_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8189	001	0	1	01	01	H8189_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8189	001	0	1	01	01	H8189_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8189	001	0	1	01	01	H8189_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8197	001	0	1	48	05	H8197_001_0	5	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H8197	001	0	1	48	05	H8197_001_0	5	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H8197	001	0	1	48	05	H8197_001_0	5	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H8211	001	0	1	04	01	H8211_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8211	001	0	1	04	01	H8211_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8211	001	0	1	04	01	H8211_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8211	001	0	1	04	01	H8211_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8211	001	0	1	04	01	H8211_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8211	002	0	1	04	01	H8211_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8211	002	0	1	04	01	H8211_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8211	002	0	1	04	01	H8211_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8211	002	0	1	04	01	H8211_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8211	002	0	1	04	01	H8211_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8211	006	0	1	04	01	H8211_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8211	006	0	1	04	01	H8211_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8211	006	0	1	04	01	H8211_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8211	006	0	1	04	01	H8211_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8211	006	0	1	04	01	H8211_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8211	007	0	1	04	01	H8211_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8211	007	0	1	04	01	H8211_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8211	007	0	1	04	01	H8211_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8211	007	0	1	04	01	H8211_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8211	007	0	1	04	01	H8211_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8213	001	0	1	48	05	H8213_001_0	4	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H8213	001	0	1	48	05	H8213_001_0	4	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H8213	001	0	1	48	05	H8213_001_0	4	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H8225	001	0	1	01	01	H8225_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8225	001	0	1	01	01	H8225_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8225	001	0	1	01	01	H8225_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8225	001	0	1	01	01	H8225_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8225	001	0	1	01	01	H8225_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8225	001	0	1	01	01	H8225_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8225	002	0	1	01	01	H8225_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8225	002	0	1	01	01	H8225_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8225	002	0	1	01	01	H8225_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8225	002	0	1	01	01	H8225_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8225	002	0	1	01	01	H8225_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8225	002	0	1	01	01	H8225_002_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8225	003	0	1	01	01	H8225_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8225	003	0	1	01	01	H8225_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8225	003	0	1	01	01	H8225_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8225	003	0	1	01	01	H8225_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8225	003	0	1	01	01	H8225_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8225	003	0	1	01	01	H8225_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8225	004	0	1	01	01	H8225_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8225	004	0	1	01	01	H8225_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8225	004	0	1	01	01	H8225_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8225	004	0	1	01	01	H8225_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8225	004	0	1	01	01	H8225_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8225	004	0	1	01	01	H8225_004_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8258	001	0	1	48	05	H8258_001_0	7	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	2	01					1	0.00	0.00
H8258	001	0	1	48	05	H8258_001_0	7	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	2	10					1	0.00	0.00
H8258	001	0	1	48	05	H8258_001_0	7	Non-Medicare Rx Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	3	2	11					2	0.00	0.00
H8258	001	0	1	48	05	H8258_001_0	7	Non-Medicare OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	4	2	11					2	0.00	0.00
H8280	001	0	1	01	01	H8280_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H8280	001	0	1	01	01	H8280_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H8280	001	0	1	01	01	H8280_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8280	001	0	1	01	01	H8280_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8280	001	0	1	01	01	H8280_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8280	001	0	1	01	01	H8280_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H8280	002	0	1	01	01	H8280_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H8280	002	0	1	01	01	H8280_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H8280	002	0	1	01	01	H8280_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8280	002	0	1	01	01	H8280_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8280	002	0	1	01	01	H8280_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8280	002	0	1	01	01	H8280_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H8293	001	0	1	01	01	H8293_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8293	001	0	1	01	01	H8293_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8293	001	0	1	01	01	H8293_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H8293	001	0	1	01	01	H8293_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H8293	001	0	1	01	01	H8293_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8332	001	0	1	01	01	H8332_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8332	001	0	1	01	01	H8332_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8332	001	0	1	01	01	H8332_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8332	001	0	1	01	01	H8332_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8332	001	0	1	01	01	H8332_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8332	002	0	1	01	01	H8332_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8332	002	0	1	01	01	H8332_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8332	002	0	1	01	01	H8332_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8332	002	0	1	01	01	H8332_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8332	002	0	1	01	01	H8332_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8343	001	0	1	04	01	H8343_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8343	001	0	1	04	01	H8343_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8343	001	0	1	04	01	H8343_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8343	001	0	1	04	01	H8343_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8343	001	0	1	04	01	H8343_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8343	001	0	1	04	01	H8343_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8343	002	0	1	04	01	H8343_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8343	002	0	1	04	01	H8343_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8343	002	0	1	04	01	H8343_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8343	002	0	1	04	01	H8343_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8343	002	0	1	04	01	H8343_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8343	002	0	1	04	01	H8343_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8343	003	0	1	04	01	H8343_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8343	003	0	1	04	01	H8343_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8343	003	0	1	04	01	H8343_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8343	003	0	1	04	01	H8343_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8343	003	0	1	04	01	H8343_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8343	003	0	1	04	01	H8343_003_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8364	002	0	1	04	01	H8364_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H8364	002	0	1	04	01	H8364_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H8364	002	0	1	04	01	H8364_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8364	002	0	1	04	01	H8364_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8364	002	0	1	04	01	H8364_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8364	002	0	1	04	01	H8364_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H8390	011	0	1	01	01	H8390_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H8390	011	0	1	01	01	H8390_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H8390	011	0	1	01	01	H8390_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8390	011	0	1	01	01	H8390_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8390	011	0	1	01	01	H8390_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8390	011	0	1	01	01	H8390_011_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8390	012	0	1	01	01	H8390_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H8390	012	0	1	01	01	H8390_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H8390	012	0	1	01	01	H8390_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8390	012	0	1	01	01	H8390_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8390	012	0	1	01	01	H8390_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8390	012	0	1	01	01	H8390_012_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8390	013	0	1	01	01	H8390_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H8390	013	0	1	01	01	H8390_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H8390	013	0	1	01	01	H8390_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8390	013	0	1	01	01	H8390_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8390	013	0	1	01	01	H8390_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8390	013	0	1	01	01	H8390_013_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8390	014	0	1	01	01	H8390_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H8390	014	0	1	01	01	H8390_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H8390	014	0	1	01	01	H8390_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8390	014	0	1	01	01	H8390_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8390	014	0	1	01	01	H8390_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8390	014	0	1	01	01	H8390_014_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8390	015	0	1	01	01	H8390_015_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H8390	015	0	1	01	01	H8390_015_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H8390	015	0	1	01	01	H8390_015_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8390	015	0	1	01	01	H8390_015_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8390	015	0	1	01	01	H8390_015_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8390	015	0	1	01	01	H8390_015_0	3	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8390	016	0	1	01	01	H8390_016_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H8390	016	0	1	01	01	H8390_016_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H8390	016	0	1	01	01	H8390_016_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8390	016	0	1	01	01	H8390_016_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8390	016	0	1	01	01	H8390_016_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8390	016	0	1	01	01	H8390_016_0	3	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H8423	001	0	1	48	05	H8423_001_0	3	Generic Drugs	4	Generic Drugs, Brand Drugs	1	2	01					3	0.00	0.00
H8423	001	0	1	48	05	H8423_001_0	3	Brand Drugs	4	Generic Drugs, Brand Drugs	2	2	10					1	0.00	0.00
H8432	007	0	1	01	01	H8432_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8432	007	0	1	01	01	H8432_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	007	0	1	01	01	H8432_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	007	0	1	01	01	H8432_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	007	0	1	01	01	H8432_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	007	0	1	01	01	H8432_007_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8432	008	5	1	01	01	H8432_008_5	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8432	008	5	1	01	01	H8432_008_5	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8432	008	5	1	01	01	H8432_008_5	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8432	008	5	1	01	01	H8432_008_5	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8432	008	5	1	01	01	H8432_008_5	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8432	008	6	1	01	01	H8432_008_6	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8432	008	6	1	01	01	H8432_008_6	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8432	008	6	1	01	01	H8432_008_6	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8432	008	6	1	01	01	H8432_008_6	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8432	008	6	1	01	01	H8432_008_6	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8432	008	7	1	01	01	H8432_008_7	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8432	008	7	1	01	01	H8432_008_7	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8432	008	7	1	01	01	H8432_008_7	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8432	008	7	1	01	01	H8432_008_7	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8432	008	7	1	01	01	H8432_008_7	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8432	009	0	1	01	01	H8432_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8432	009	0	1	01	01	H8432_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8432	009	0	1	01	01	H8432_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8432	009	0	1	01	01	H8432_009_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8432	009	0	1	01	01	H8432_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8432	010	0	1	01	01	H8432_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8432	010	0	1	01	01	H8432_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8432	010	0	1	01	01	H8432_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8432	010	0	1	01	01	H8432_010_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8432	010	0	1	01	01	H8432_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8432	011	0	1	01	01	H8432_011_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8432	011	0	1	01	01	H8432_011_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8432	011	0	1	01	01	H8432_011_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8432	011	0	1	01	01	H8432_011_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8432	011	0	1	01	01	H8432_011_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8432	015	0	1	02	01	H8432_015_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8432	015	0	1	02	01	H8432_015_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8432	015	0	1	02	01	H8432_015_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8432	015	0	1	02	01	H8432_015_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8432	015	0	1	02	01	H8432_015_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8432	016	0	1	01	01	H8432_016_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8432	016	0	1	01	01	H8432_016_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	016	0	1	01	01	H8432_016_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	016	0	1	01	01	H8432_016_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	016	0	1	01	01	H8432_016_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	016	0	1	01	01	H8432_016_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8432	027	0	1	01	01	H8432_027_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H8432	027	0	1	01	01	H8432_027_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	027	0	1	01	01	H8432_027_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	027	0	1	01	01	H8432_027_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	027	0	1	01	01	H8432_027_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	027	0	1	01	01	H8432_027_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8432	028	0	1	01	01	H8432_028_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H8432	028	0	1	01	01	H8432_028_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	028	0	1	01	01	H8432_028_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	028	0	1	01	01	H8432_028_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	028	0	1	01	01	H8432_028_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	028	0	1	01	01	H8432_028_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8432	032	0	1	01	01	H8432_032_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H8432	032	0	1	01	01	H8432_032_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	032	0	1	01	01	H8432_032_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	032	0	1	01	01	H8432_032_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	032	0	1	01	01	H8432_032_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	032	0	1	01	01	H8432_032_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8432	033	0	1	01	01	H8432_033_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H8432	033	0	1	01	01	H8432_033_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	033	0	1	01	01	H8432_033_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	033	0	1	01	01	H8432_033_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	033	0	1	01	01	H8432_033_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	033	0	1	01	01	H8432_033_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8432	034	0	1	01	01	H8432_034_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8432	034	0	1	01	01	H8432_034_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	034	0	1	01	01	H8432_034_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	034	0	1	01	01	H8432_034_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	034	0	1	01	01	H8432_034_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	034	0	1	01	01	H8432_034_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8432	035	0	1	01	01	H8432_035_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H8432	035	0	1	01	01	H8432_035_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	035	0	1	01	01	H8432_035_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	035	0	1	01	01	H8432_035_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	035	0	1	01	01	H8432_035_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	035	0	1	01	01	H8432_035_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8432	038	1	1	01	01	H8432_038_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8432	038	1	1	01	01	H8432_038_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8432	038	1	1	01	01	H8432_038_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8432	038	1	1	01	01	H8432_038_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8432	038	1	1	01	01	H8432_038_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8432	038	2	1	01	01	H8432_038_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8432	038	2	1	01	01	H8432_038_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8432	038	2	1	01	01	H8432_038_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8432	038	2	1	01	01	H8432_038_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8432	038	2	1	01	01	H8432_038_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8432	039	1	1	01	01	H8432_039_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8432	039	1	1	01	01	H8432_039_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	039	1	1	01	01	H8432_039_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	039	1	1	01	01	H8432_039_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	039	1	1	01	01	H8432_039_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	039	1	1	01	01	H8432_039_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8432	039	2	1	01	01	H8432_039_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8432	039	2	1	01	01	H8432_039_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8432	039	2	1	01	01	H8432_039_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8432	039	2	1	01	01	H8432_039_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8432	039	2	1	01	01	H8432_039_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8432	039	2	1	01	01	H8432_039_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8452	001	0	1	48	05	H8452_001_0	6	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	11					1	0.00	0.00
H8452	001	0	1	48	05	H8452_001_0	6	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H8452	001	0	1	48	05	H8452_001_0	6	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H8547	001	0	1	01	01	H8547_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8547	001	0	1	01	01	H8547_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8547	001	0	1	01	01	H8547_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8547	001	0	1	01	01	H8547_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8547	001	0	1	01	01	H8547_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8552	020	0	1	04	01	H8552_020_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8552	020	0	1	04	01	H8552_020_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8552	020	0	1	04	01	H8552_020_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8552	020	0	1	04	01	H8552_020_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8552	020	0	1	04	01	H8552_020_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8552	020	0	1	04	01	H8552_020_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8552	028	0	1	04	01	H8552_028_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8552	028	0	1	04	01	H8552_028_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8552	028	0	1	04	01	H8552_028_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8552	028	0	1	04	01	H8552_028_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8552	028	0	1	04	01	H8552_028_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8552	028	0	1	04	01	H8552_028_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8552	029	0	1	04	01	H8552_029_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8552	029	0	1	04	01	H8552_029_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8552	029	0	1	04	01	H8552_029_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8552	029	0	1	04	01	H8552_029_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8552	029	0	1	04	01	H8552_029_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8552	029	0	1	04	01	H8552_029_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8552	030	0	1	04	01	H8552_030_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8552	030	0	1	04	01	H8552_030_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8552	030	0	1	04	01	H8552_030_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8552	030	0	1	04	01	H8552_030_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8552	030	0	1	04	01	H8552_030_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8552	030	0	1	04	01	H8552_030_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8553	001	0	1	04	01	H8553_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H8553	001	0	1	04	01	H8553_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8553	001	0	1	04	01	H8553_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8553	001	0	1	04	01	H8553_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8553	001	0	1	04	01	H8553_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8553	003	0	1	04	01	H8553_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H8553	003	0	1	04	01	H8553_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8553	003	0	1	04	01	H8553_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8553	003	0	1	04	01	H8553_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8553	003	0	1	04	01	H8553_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8554	001	0	1	01	01	H8554_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8554	001	0	1	01	01	H8554_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8554	001	0	1	01	01	H8554_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8554	001	0	1	01	01	H8554_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8554	001	0	1	01	01	H8554_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8578	001	0	1	01	01	H8578_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8578	001	0	1	01	01	H8578_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8578	001	0	1	01	01	H8578_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8578	001	0	1	01	01	H8578_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H8578	001	0	1	01	01	H8578_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8578	004	0	1	01	01	H8578_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8578	004	0	1	01	01	H8578_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8578	004	0	1	01	01	H8578_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8578	004	0	1	01	01	H8578_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H8578	004	0	1	01	01	H8578_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8578	012	0	1	01	01	H8578_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8578	012	0	1	01	01	H8578_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8578	012	0	1	01	01	H8578_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8578	012	0	1	01	01	H8578_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H8578	012	0	1	01	01	H8578_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8578	016	0	1	02	01	H8578_016_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8578	016	0	1	02	01	H8578_016_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8578	016	0	1	02	01	H8578_016_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8578	016	0	1	02	01	H8578_016_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H8578	016	0	1	02	01	H8578_016_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8578	017	0	1	01	01	H8578_017_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8578	017	0	1	01	01	H8578_017_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8578	017	0	1	01	01	H8578_017_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8578	017	0	1	01	01	H8578_017_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	3						
H8578	017	0	1	01	01	H8578_017_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8597	001	0	1	01	01	H8597_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8597	001	0	1	01	01	H8597_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8597	001	0	1	01	01	H8597_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8597	001	0	1	01	01	H8597_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8597	001	0	1	01	01	H8597_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8597	002	0	1	01	01	H8597_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8597	002	0	1	01	01	H8597_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8597	002	0	1	01	01	H8597_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8597	002	0	1	01	01	H8597_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8597	002	0	1	01	01	H8597_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8597	003	0	1	01	01	H8597_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8597	003	0	1	01	01	H8597_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8597	003	0	1	01	01	H8597_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8597	003	0	1	01	01	H8597_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8597	003	0	1	01	01	H8597_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8604	010	0	1	04	01	H8604_010_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8604	010	0	1	04	01	H8604_010_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8604	010	0	1	04	01	H8604_010_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8604	010	0	1	04	01	H8604_010_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8604	010	0	1	04	01	H8604_010_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8604	011	0	1	04	01	H8604_011_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8604	011	0	1	04	01	H8604_011_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8604	011	0	1	04	01	H8604_011_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8604	011	0	1	04	01	H8604_011_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8604	011	0	1	04	01	H8604_011_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8604	013	0	1	04	01	H8604_013_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8604	013	0	1	04	01	H8604_013_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8604	013	0	1	04	01	H8604_013_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8604	013	0	1	04	01	H8604_013_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8604	013	0	1	04	01	H8604_013_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8634	002	0	1	04	01	H8634_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8634	002	0	1	04	01	H8634_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8634	002	0	1	04	01	H8634_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8634	002	0	1	04	01	H8634_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8634	002	0	1	04	01	H8634_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8634	003	0	1	04	01	H8634_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8634	003	0	1	04	01	H8634_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8634	003	0	1	04	01	H8634_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8634	003	0	1	04	01	H8634_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8634	003	0	1	04	01	H8634_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8634	004	0	1	04	01	H8634_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8634	004	0	1	04	01	H8634_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8634	004	0	1	04	01	H8634_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8634	004	0	1	04	01	H8634_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8634	004	0	1	04	01	H8634_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8634	007	0	1	04	01	H8634_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8634	007	0	1	04	01	H8634_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8634	007	0	1	04	01	H8634_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8634	007	0	1	04	01	H8634_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8634	007	0	1	04	01	H8634_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8634	008	0	1	04	01	H8634_008_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8634	008	0	1	04	01	H8634_008_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8634	008	0	1	04	01	H8634_008_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8634	008	0	1	04	01	H8634_008_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8634	008	0	1	04	01	H8634_008_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8649	003	0	1	01	01	H8649_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8649	003	0	1	01	01	H8649_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8649	003	0	1	01	01	H8649_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8649	003	0	1	01	01	H8649_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8649	003	0	1	01	01	H8649_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8649	008	0	1	01	01	H8649_008_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8649	008	0	1	01	01	H8649_008_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8649	008	0	1	01	01	H8649_008_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8649	008	0	1	01	01	H8649_008_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8649	008	0	1	01	01	H8649_008_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8677	001	0	1	48	05	H8677_001_0	5	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H8677	001	0	1	48	05	H8677_001_0	5	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H8677	001	0	1	48	05	H8677_001_0	5	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H8677	002	0	1	48	05	H8677_002_0	5	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H8677	002	0	1	48	05	H8677_002_0	5	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	11					1	0.00	0.00
H8677	002	0	1	48	05	H8677_002_0	5	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H8711	001	0	1	04	01	H8711_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H8711	001	0	1	04	01	H8711_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8711	001	0	1	04	01	H8711_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8711	001	0	1	04	01	H8711_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8711	001	0	1	04	01	H8711_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8711	002	0	1	04	01	H8711_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H8711	002	0	1	04	01	H8711_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8711	002	0	1	04	01	H8711_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8711	002	0	1	04	01	H8711_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8711	002	0	1	04	01	H8711_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8748	002	0	1	02	01	H8748_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8748	002	0	1	02	01	H8748_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8748	002	0	1	02	01	H8748_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8748	002	0	1	02	01	H8748_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8748	002	0	1	02	01	H8748_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8748	008	0	1	02	01	H8748_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8748	008	0	1	02	01	H8748_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8748	008	0	1	02	01	H8748_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8748	008	0	1	02	01	H8748_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8748	008	0	1	02	01	H8748_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8748	009	0	1	02	01	H8748_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8748	009	0	1	02	01	H8748_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8748	009	0	1	02	01	H8748_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8748	009	0	1	02	01	H8748_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8748	009	0	1	02	01	H8748_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8748	025	0	1	02	01	H8748_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8748	025	0	1	02	01	H8748_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8748	025	0	1	02	01	H8748_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8748	025	0	1	02	01	H8748_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8748	025	0	1	02	01	H8748_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8764	001	0	1	01	01	H8764_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H8764	001	0	1	01	01	H8764_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	01	1						
H8764	001	0	1	01	01	H8764_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H8764	001	0	1	01	01	H8764_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H8764	001	0	1	01	01	H8764_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H8764	001	0	1	01	01	H8764_001_0	4	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H8764	002	0	1	02	01	H8764_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H8764	002	0	1	02	01	H8764_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	01	1						
H8764	002	0	1	02	01	H8764_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H8764	002	0	1	02	01	H8764_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H8764	002	0	1	02	01	H8764_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H8764	002	0	1	02	01	H8764_002_0	5	Select Diabetic Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H8764	003	0	1	01	01	H8764_003_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	1	2	01	1						
H8764	003	0	1	01	01	H8764_003_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	2	2	01	1						
H8764	003	0	1	01	01	H8764_003_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	3	2	10	1						
H8764	003	0	1	01	01	H8764_003_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	4	2	11	1						
H8764	003	0	1	01	01	H8764_003_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	5	2	11	1						
H8764	003	0	1	01	01	H8764_003_0	4	Select Diabetic Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs	6	2	11	1						
H8768	003	0	1	04	01	H8768_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	003	0	1	04	01	H8768_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	003	0	1	04	01	H8768_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	003	0	1	04	01	H8768_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	003	0	1	04	01	H8768_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	005	0	1	04	01	H8768_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	005	0	1	04	01	H8768_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	005	0	1	04	01	H8768_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	005	0	1	04	01	H8768_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	005	0	1	04	01	H8768_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	006	0	1	04	01	H8768_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	006	0	1	04	01	H8768_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	006	0	1	04	01	H8768_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	006	0	1	04	01	H8768_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	006	0	1	04	01	H8768_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	007	0	1	04	01	H8768_007_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	007	0	1	04	01	H8768_007_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	007	0	1	04	01	H8768_007_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	007	0	1	04	01	H8768_007_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	007	0	1	04	01	H8768_007_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	008	0	1	04	01	H8768_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	008	0	1	04	01	H8768_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	008	0	1	04	01	H8768_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	008	0	1	04	01	H8768_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	008	0	1	04	01	H8768_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	009	0	1	04	01	H8768_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	009	0	1	04	01	H8768_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	009	0	1	04	01	H8768_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	009	0	1	04	01	H8768_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	009	0	1	04	01	H8768_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	010	0	1	04	01	H8768_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	010	0	1	04	01	H8768_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	010	0	1	04	01	H8768_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	010	0	1	04	01	H8768_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	010	0	1	04	01	H8768_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	011	0	1	04	01	H8768_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	011	0	1	04	01	H8768_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	011	0	1	04	01	H8768_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	011	0	1	04	01	H8768_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	011	0	1	04	01	H8768_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	012	0	1	04	01	H8768_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	012	0	1	04	01	H8768_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	012	0	1	04	01	H8768_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	012	0	1	04	01	H8768_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	012	0	1	04	01	H8768_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	013	0	1	04	01	H8768_013_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	013	0	1	04	01	H8768_013_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	013	0	1	04	01	H8768_013_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	013	0	1	04	01	H8768_013_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	013	0	1	04	01	H8768_013_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	014	0	1	04	01	H8768_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	014	0	1	04	01	H8768_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	014	0	1	04	01	H8768_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	014	0	1	04	01	H8768_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	014	0	1	04	01	H8768_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	015	0	1	04	01	H8768_015_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	015	0	1	04	01	H8768_015_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	015	0	1	04	01	H8768_015_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	015	0	1	04	01	H8768_015_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	015	0	1	04	01	H8768_015_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	016	0	1	04	01	H8768_016_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	016	0	1	04	01	H8768_016_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	016	0	1	04	01	H8768_016_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	016	0	1	04	01	H8768_016_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	016	0	1	04	01	H8768_016_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	017	1	1	04	01	H8768_017_1	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	017	1	1	04	01	H8768_017_1	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	017	1	1	04	01	H8768_017_1	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	017	1	1	04	01	H8768_017_1	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	017	1	1	04	01	H8768_017_1	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	017	2	1	04	01	H8768_017_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	017	2	1	04	01	H8768_017_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	017	2	1	04	01	H8768_017_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	017	2	1	04	01	H8768_017_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	017	2	1	04	01	H8768_017_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	022	0	1	04	01	H8768_022_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	022	0	1	04	01	H8768_022_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	022	0	1	04	01	H8768_022_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	022	0	1	04	01	H8768_022_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	022	0	1	04	01	H8768_022_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	023	0	1	04	01	H8768_023_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	023	0	1	04	01	H8768_023_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	023	0	1	04	01	H8768_023_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	023	0	1	04	01	H8768_023_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	023	0	1	04	01	H8768_023_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	024	0	1	04	01	H8768_024_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	024	0	1	04	01	H8768_024_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	024	0	1	04	01	H8768_024_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	024	0	1	04	01	H8768_024_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	024	0	1	04	01	H8768_024_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	026	0	1	04	01	H8768_026_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	026	0	1	04	01	H8768_026_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	026	0	1	04	01	H8768_026_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	026	0	1	04	01	H8768_026_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	026	0	1	04	01	H8768_026_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	027	0	1	04	01	H8768_027_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	027	0	1	04	01	H8768_027_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	027	0	1	04	01	H8768_027_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	027	0	1	04	01	H8768_027_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	027	0	1	04	01	H8768_027_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	029	0	1	04	01	H8768_029_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	029	0	1	04	01	H8768_029_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	029	0	1	04	01	H8768_029_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	029	0	1	04	01	H8768_029_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	029	0	1	04	01	H8768_029_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8768	030	0	1	04	01	H8768_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8768	030	0	1	04	01	H8768_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
H8768	030	0	1	04	01	H8768_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8768	030	0	1	04	01	H8768_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8768	030	0	1	04	01	H8768_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8783	001	0	1	04	01	H8783_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8783	001	0	1	04	01	H8783_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8783	001	0	1	04	01	H8783_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8783	001	0	1	04	01	H8783_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8783	001	0	1	04	01	H8783_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8783	002	0	1	04	01	H8783_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8783	002	0	1	04	01	H8783_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8783	002	0	1	04	01	H8783_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8783	002	0	1	04	01	H8783_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8783	002	0	1	04	01	H8783_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8783	003	0	1	04	01	H8783_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8783	003	0	1	04	01	H8783_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8783	003	0	1	04	01	H8783_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8783	003	0	1	04	01	H8783_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8783	003	0	1	04	01	H8783_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8786	001	0	1	48	05	H8786_001_0	10	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	2	11					1	0.00	0.00
H8786	001	0	1	48	05	H8786_001_0	10	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	2	11					1	0.00	0.00
H8786	001	0	1	48	05	H8786_001_0	10	Non-Medicare Rx Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	3	2	11					2	0.00	0.00
H8786	001	0	1	48	05	H8786_001_0	10	Non-Medicare OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	4	2	11					2	0.00	0.00
H8797	002	0	1	01	01	H8797_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H8797	002	0	1	01	01	H8797_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H8797	002	0	1	01	01	H8797_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H8797	002	0	1	01	01	H8797_002_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H8797	002	0	1	01	01	H8797_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H8849	001	0	1	01	01	H8849_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H8849	001	0	1	01	01	H8849_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	001	0	1	01	01	H8849_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	001	0	1	01	01	H8849_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	001	0	1	01	01	H8849_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	001	0	1	01	01	H8849_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H8849	002	0	1	01	01	H8849_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H8849	002	0	1	01	01	H8849_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	002	0	1	01	01	H8849_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	002	0	1	01	01	H8849_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	002	0	1	01	01	H8849_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	002	0	1	01	01	H8849_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H8849	003	0	1	01	01	H8849_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H8849	003	0	1	01	01	H8849_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	003	0	1	01	01	H8849_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	003	0	1	01	01	H8849_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	003	0	1	01	01	H8849_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	003	0	1	01	01	H8849_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H8849	004	0	1	01	01	H8849_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H8849	004	0	1	01	01	H8849_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	004	0	1	01	01	H8849_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	004	0	1	01	01	H8849_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	004	0	1	01	01	H8849_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	004	0	1	01	01	H8849_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H8849	005	0	1	01	01	H8849_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1	2	0.00				
H8849	005	0	1	01	01	H8849_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	005	0	1	01	01	H8849_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	005	0	1	01	01	H8849_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	005	0	1	01	01	H8849_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	005	0	1	01	01	H8849_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1	2	0.00				
H8849	006	0	1	01	01	H8849_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H8849	006	0	1	01	01	H8849_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8849	006	0	1	01	01	H8849_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8849	006	0	1	01	01	H8849_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8849	006	0	1	01	01	H8849_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8849	006	0	1	01	01	H8849_006_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8849	007	0	1	01	01	H8849_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8849	007	0	1	01	01	H8849_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8849	007	0	1	01	01	H8849_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8849	007	0	1	01	01	H8849_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8849	007	0	1	01	01	H8849_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8849	007	0	1	01	01	H8849_007_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8849	008	1	1	01	01	H8849_008_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8849	008	1	1	01	01	H8849_008_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8849	008	1	1	01	01	H8849_008_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8849	008	1	1	01	01	H8849_008_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8849	008	1	1	01	01	H8849_008_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8849	008	1	1	01	01	H8849_008_1	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8849	008	2	1	01	01	H8849_008_2	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8849	008	2	1	01	01	H8849_008_2	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8849	008	2	1	01	01	H8849_008_2	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8849	008	2	1	01	01	H8849_008_2	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8849	008	2	1	01	01	H8849_008_2	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8849	008	2	1	01	01	H8849_008_2	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8849	008	3	1	01	01	H8849_008_3	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8849	008	3	1	01	01	H8849_008_3	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8849	008	3	1	01	01	H8849_008_3	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8849	008	3	1	01	01	H8849_008_3	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8849	008	3	1	01	01	H8849_008_3	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8849	008	3	1	01	01	H8849_008_3	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8849	008	4	1	01	01	H8849_008_4	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8849	008	4	1	01	01	H8849_008_4	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8849	008	4	1	01	01	H8849_008_4	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8849	008	4	1	01	01	H8849_008_4	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8849	008	4	1	01	01	H8849_008_4	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8849	008	4	1	01	01	H8849_008_4	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8849	008	5	1	01	01	H8849_008_5	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8849	008	5	1	01	01	H8849_008_5	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8849	008	5	1	01	01	H8849_008_5	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8849	008	5	1	01	01	H8849_008_5	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8849	008	5	1	01	01	H8849_008_5	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8849	008	5	1	01	01	H8849_008_5	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8849	008	6	1	01	01	H8849_008_6	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H8849	008	6	1	01	01	H8849_008_6	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8849	008	6	1	01	01	H8849_008_6	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8849	008	6	1	01	01	H8849_008_6	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8849	008	6	1	01	01	H8849_008_6	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8849	008	6	1	01	01	H8849_008_6	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8849	009	0	1	01	01	H8849_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H8849	009	0	1	01	01	H8849_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H8849	009	0	1	01	01	H8849_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H8849	009	0	1	01	01	H8849_009_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H8849	009	0	1	01	01	H8849_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H8849	009	0	1	01	01	H8849_009_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H8849	010	1	1	01	01	H8849_010_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	010	1	1	01	01	H8849_010_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	010	1	1	01	01	H8849_010_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	010	1	1	01	01	H8849_010_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	010	1	1	01	01	H8849_010_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	010	1	1	01	01	H8849_010_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	010	2	1	01	01	H8849_010_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	010	2	1	01	01	H8849_010_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	010	2	1	01	01	H8849_010_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	010	2	1	01	01	H8849_010_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	010	2	1	01	01	H8849_010_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	010	2	1	01	01	H8849_010_2	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	010	3	1	01	01	H8849_010_3	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	010	3	1	01	01	H8849_010_3	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	010	3	1	01	01	H8849_010_3	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	010	3	1	01	01	H8849_010_3	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	010	3	1	01	01	H8849_010_3	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	010	3	1	01	01	H8849_010_3	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	010	4	1	01	01	H8849_010_4	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	010	4	1	01	01	H8849_010_4	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	010	4	1	01	01	H8849_010_4	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	010	4	1	01	01	H8849_010_4	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	010	4	1	01	01	H8849_010_4	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	010	4	1	01	01	H8849_010_4	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	010	5	1	01	01	H8849_010_5	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	010	5	1	01	01	H8849_010_5	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	010	5	1	01	01	H8849_010_5	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	010	5	1	01	01	H8849_010_5	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	010	5	1	01	01	H8849_010_5	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	010	5	1	01	01	H8849_010_5	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	010	6	1	01	01	H8849_010_6	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	010	6	1	01	01	H8849_010_6	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	010	6	1	01	01	H8849_010_6	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	010	6	1	01	01	H8849_010_6	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	010	6	1	01	01	H8849_010_6	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	010	6	1	01	01	H8849_010_6	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	011	1	1	01	01	H8849_011_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	011	1	1	01	01	H8849_011_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	011	1	1	01	01	H8849_011_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	011	1	1	01	01	H8849_011_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	011	1	1	01	01	H8849_011_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	011	1	1	01	01	H8849_011_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	011	2	1	01	01	H8849_011_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	011	2	1	01	01	H8849_011_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	011	2	1	01	01	H8849_011_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	011	2	1	01	01	H8849_011_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	011	2	1	01	01	H8849_011_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	011	2	1	01	01	H8849_011_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	011	3	1	01	01	H8849_011_3	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	011	3	1	01	01	H8849_011_3	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	011	3	1	01	01	H8849_011_3	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	011	3	1	01	01	H8849_011_3	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	011	3	1	01	01	H8849_011_3	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	011	3	1	01	01	H8849_011_3	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	011	4	1	01	01	H8849_011_4	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	011	4	1	01	01	H8849_011_4	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	011	4	1	01	01	H8849_011_4	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	011	4	1	01	01	H8849_011_4	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	011	4	1	01	01	H8849_011_4	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	011	4	1	01	01	H8849_011_4	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	011	5	1	01	01	H8849_011_5	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	011	5	1	01	01	H8849_011_5	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	011	5	1	01	01	H8849_011_5	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	011	5	1	01	01	H8849_011_5	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	011	5	1	01	01	H8849_011_5	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	011	5	1	01	01	H8849_011_5	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8849	011	6	1	01	01	H8849_011_6	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3	2	0.00				
H8849	011	6	1	01	01	H8849_011_6	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1	3	3.70	5			
H8849	011	6	1	01	01	H8849_011_6	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1	3	9.20	5			
H8849	011	6	1	01	01	H8849_011_6	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1	3	9.20	5			
H8849	011	6	1	01	01	H8849_011_6	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1	3	9.20	5			
H8849	011	6	1	01	01	H8849_011_6	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1	2	0.00				
H8889	001	0	1	04	01	H8889_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8889	001	0	1	04	01	H8889_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8889	001	0	1	04	01	H8889_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8889	001	0	1	04	01	H8889_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8889	001	0	1	04	01	H8889_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8889	002	0	1	04	01	H8889_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8889	002	0	1	04	01	H8889_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8889	002	0	1	04	01	H8889_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8889	002	0	1	04	01	H8889_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8889	002	0	1	04	01	H8889_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8889	003	0	1	04	01	H8889_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8889	003	0	1	04	01	H8889_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8889	003	0	1	04	01	H8889_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8889	003	0	1	04	01	H8889_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8889	003	0	1	04	01	H8889_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8889	004	0	1	04	01	H8889_004_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8889	004	0	1	04	01	H8889_004_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8889	004	0	1	04	01	H8889_004_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8889	004	0	1	04	01	H8889_004_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8889	004	0	1	04	01	H8889_004_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8889	005	0	1	04	01	H8889_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H8889	005	0	1	04	01	H8889_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H8889	005	0	1	04	01	H8889_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8889	005	0	1	04	01	H8889_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8889	005	0	1	04	01	H8889_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8908	001	0	1	01	01	H8908_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8908	001	0	1	01	01	H8908_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8908	001	0	1	01	01	H8908_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8908	001	0	1	01	01	H8908_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8908	001	0	1	01	01	H8908_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8908	002	0	1	01	01	H8908_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8908	002	0	1	01	01	H8908_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8908	002	0	1	01	01	H8908_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8908	002	0	1	01	01	H8908_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8908	002	0	1	01	01	H8908_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8908	004	0	1	01	01	H8908_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8908	004	0	1	01	01	H8908_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8908	004	0	1	01	01	H8908_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8908	004	0	1	01	01	H8908_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8908	004	0	1	01	01	H8908_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8908	005	0	1	01	01	H8908_005_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8908	005	0	1	01	01	H8908_005_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H8908	005	0	1	01	01	H8908_005_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8908	005	0	1	01	01	H8908_005_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8908	005	0	1	01	01	H8908_005_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8961	001	0	1	01	01	H8961_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H8961	001	0	1	01	01	H8961_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H8961	001	0	1	01	01	H8961_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H8961	001	0	1	01	01	H8961_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H8961	001	0	1	01	01	H8961_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H8967	002	0	1	01	01	H8967_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H8967	002	0	1	01	01	H8967_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H8967	002	0	1	01	01	H8967_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H8967	002	0	1	01	01	H8967_002_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H8967	002	0	1	01	01	H8967_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H9001	030	14	1	01	01	H9001_030_14	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	030	14	1	01	01	H9001_030_14	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	030	14	1	01	01	H9001_030_14	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	030	14	1	01	01	H9001_030_14	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	030	14	1	01	01	H9001_030_14	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	030	14	1	01	01	H9001_030_14	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	030	15	1	01	01	H9001_030_15	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	030	15	1	01	01	H9001_030_15	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	030	15	1	01	01	H9001_030_15	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	030	15	1	01	01	H9001_030_15	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	030	15	1	01	01	H9001_030_15	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	030	15	1	01	01	H9001_030_15	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	030	16	1	01	01	H9001_030_16	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	030	16	1	01	01	H9001_030_16	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	030	16	1	01	01	H9001_030_16	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	030	16	1	01	01	H9001_030_16	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	030	16	1	01	01	H9001_030_16	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	030	16	1	01	01	H9001_030_16	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	030	17	1	01	01	H9001_030_17	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	030	17	1	01	01	H9001_030_17	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	030	17	1	01	01	H9001_030_17	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	030	17	1	01	01	H9001_030_17	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	030	17	1	01	01	H9001_030_17	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	030	17	1	01	01	H9001_030_17	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	031	14	1	01	01	H9001_031_14	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	031	14	1	01	01	H9001_031_14	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	031	14	1	01	01	H9001_031_14	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	031	14	1	01	01	H9001_031_14	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	031	14	1	01	01	H9001_031_14	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	031	14	1	01	01	H9001_031_14	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	031	15	1	01	01	H9001_031_15	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	031	15	1	01	01	H9001_031_15	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	031	15	1	01	01	H9001_031_15	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	031	15	1	01	01	H9001_031_15	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	031	15	1	01	01	H9001_031_15	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	031	15	1	01	01	H9001_031_15	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	031	16	1	01	01	H9001_031_16	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	031	16	1	01	01	H9001_031_16	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	031	16	1	01	01	H9001_031_16	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	031	16	1	01	01	H9001_031_16	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	031	16	1	01	01	H9001_031_16	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	031	16	1	01	01	H9001_031_16	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	031	17	1	01	01	H9001_031_17	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	031	17	1	01	01	H9001_031_17	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	031	17	1	01	01	H9001_031_17	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	031	17	1	01	01	H9001_031_17	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	031	17	1	01	01	H9001_031_17	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	031	17	1	01	01	H9001_031_17	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	032	14	1	01	01	H9001_032_14	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	032	14	1	01	01	H9001_032_14	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	032	14	1	01	01	H9001_032_14	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	032	14	1	01	01	H9001_032_14	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	032	14	1	01	01	H9001_032_14	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	032	14	1	01	01	H9001_032_14	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	032	15	1	01	01	H9001_032_15	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	032	15	1	01	01	H9001_032_15	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	032	15	1	01	01	H9001_032_15	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	032	15	1	01	01	H9001_032_15	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	032	15	1	01	01	H9001_032_15	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	032	15	1	01	01	H9001_032_15	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	032	16	1	01	01	H9001_032_16	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	032	16	1	01	01	H9001_032_16	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	032	16	1	01	01	H9001_032_16	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	032	16	1	01	01	H9001_032_16	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	032	16	1	01	01	H9001_032_16	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	032	16	1	01	01	H9001_032_16	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	032	17	1	01	01	H9001_032_17	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	032	17	1	01	01	H9001_032_17	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	032	17	1	01	01	H9001_032_17	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	032	17	1	01	01	H9001_032_17	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	032	17	1	01	01	H9001_032_17	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	032	17	1	01	01	H9001_032_17	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	034	14	1	01	01	H9001_034_14	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	034	14	1	01	01	H9001_034_14	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	034	14	1	01	01	H9001_034_14	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	034	14	1	01	01	H9001_034_14	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	034	14	1	01	01	H9001_034_14	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	034	14	1	01	01	H9001_034_14	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	034	15	1	01	01	H9001_034_15	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	034	15	1	01	01	H9001_034_15	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	034	15	1	01	01	H9001_034_15	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	034	15	1	01	01	H9001_034_15	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	034	15	1	01	01	H9001_034_15	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	034	15	1	01	01	H9001_034_15	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	034	16	1	01	01	H9001_034_16	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	034	16	1	01	01	H9001_034_16	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	034	16	1	01	01	H9001_034_16	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	034	16	1	01	01	H9001_034_16	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	034	16	1	01	01	H9001_034_16	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	034	16	1	01	01	H9001_034_16	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	034	17	1	01	01	H9001_034_17	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	034	17	1	01	01	H9001_034_17	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	034	17	1	01	01	H9001_034_17	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	034	17	1	01	01	H9001_034_17	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	034	17	1	01	01	H9001_034_17	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	034	17	1	01	01	H9001_034_17	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	035	0	1	01	01	H9001_035_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	035	0	1	01	01	H9001_035_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	035	0	1	01	01	H9001_035_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	035	0	1	01	01	H9001_035_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	035	0	1	01	01	H9001_035_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	035	0	1	01	01	H9001_035_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	036	0	1	01	01	H9001_036_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	036	0	1	01	01	H9001_036_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	036	0	1	01	01	H9001_036_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	036	0	1	01	01	H9001_036_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	036	0	1	01	01	H9001_036_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	036	0	1	01	01	H9001_036_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9001	037	0	1	01	01	H9001_037_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1	2	11	1						
H9001	037	0	1	01	01	H9001_037_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	2	2	11	1						
H9001	037	0	1	01	01	H9001_037_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	3	2	11	1						
H9001	037	0	1	01	01	H9001_037_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	4	2	11	1						
H9001	037	0	1	01	01	H9001_037_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	5	2	11	1						
H9001	037	0	1	01	01	H9001_037_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	6	2	11	1						
H9003	001	0	1	01	01	H9003_001_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	5.00				
H9003	001	0	1	01	01	H9003_001_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	5.00				
H9003	001	0	1	01	01	H9003_001_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	15.00				
H9003	001	0	1	01	01	H9003_001_0	10	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	15.00				
H9003	001	0	1	01	01	H9003_001_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	15.00				
H9003	001	0	1	01	01	H9003_001_0	10	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H9003	006	0	1	01	01	H9003_006_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	5.00				
H9003	006	0	1	01	01	H9003_006_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	5.00				
H9003	006	0	1	01	01	H9003_006_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	15.00				
H9003	006	0	1	01	01	H9003_006_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	15.00				
H9003	006	0	1	01	01	H9003_006_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	15.00				
H9003	006	0	1	01	01	H9003_006_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H9003	007	0	1	01	01	H9003_007_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	4.00				
H9003	007	0	1	01	01	H9003_007_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	4.00				
H9003	007	0	1	01	01	H9003_007_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	10.00				
H9003	007	0	1	01	01	H9003_007_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	10.00				
H9003	007	0	1	01	01	H9003_007_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	10.00				
H9003	007	0	1	01	01	H9003_007_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H9003	008	0	1	01	01	H9003_008_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	4.00				
H9003	008	0	1	01	01	H9003_008_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	4.00				
H9003	008	0	1	01	01	H9003_008_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	10.00				
H9003	008	0	1	01	01	H9003_008_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	10.00				
H9003	008	0	1	01	01	H9003_008_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	10.00				
H9003	008	0	1	01	01	H9003_008_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H9003	009	0	1	01	01	H9003_009_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1	2	5.00				
H9003	009	0	1	01	01	H9003_009_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	11	1	2	5.00				
H9003	009	0	1	01	01	H9003_009_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	10	1	2	15.00				
H9003	009	0	1	01	01	H9003_009_0	9	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1	2	15.00				
H9003	009	0	1	01	01	H9003_009_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1	2	15.00				
H9003	009	0	1	01	01	H9003_009_0	9	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	10	1	2	0.00				
H9042	001	1	1	04	01	H9042_001_1	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9042	001	1	1	04	01	H9042_001_1	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9042	001	1	1	04	01	H9042_001_1	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9042	001	1	1	04	01	H9042_001_1	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9042	001	1	1	04	01	H9042_001_1	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9042	001	2	1	04	01	H9042_001_2	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9042	001	2	1	04	01	H9042_001_2	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9042	001	2	1	04	01	H9042_001_2	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9042	001	2	1	04	01	H9042_001_2	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9042	001	2	1	04	01	H9042_001_2	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	013	0	2	01	01	H9047_013_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	013	0	2	01	01	H9047_013_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	013	0	2	01	01	H9047_013_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	013	0	2	01	01	H9047_013_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	013	0	2	01	01	H9047_013_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	037	0	1	01	01	H9047_037_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	037	0	1	01	01	H9047_037_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	037	0	1	01	01	H9047_037_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	037	0	1	01	01	H9047_037_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	037	0	1	01	01	H9047_037_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	038	0	1	02	01	H9047_038_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	038	0	1	02	01	H9047_038_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	038	0	1	02	01	H9047_038_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	038	0	1	02	01	H9047_038_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	038	0	1	02	01	H9047_038_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	039	0	1	02	01	H9047_039_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	039	0	1	02	01	H9047_039_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	039	0	1	02	01	H9047_039_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	039	0	1	02	01	H9047_039_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	039	0	1	02	01	H9047_039_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	045	0	1	01	01	H9047_045_0	5	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	045	0	1	01	01	H9047_045_0	5	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	045	0	1	01	01	H9047_045_0	5	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	045	0	1	01	01	H9047_045_0	5	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	045	0	1	01	01	H9047_045_0	5	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	047	0	1	02	01	H9047_047_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	047	0	1	02	01	H9047_047_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	047	0	1	02	01	H9047_047_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	047	0	1	02	01	H9047_047_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	047	0	1	02	01	H9047_047_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	049	0	1	01	01	H9047_049_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	049	0	1	01	01	H9047_049_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	049	0	1	01	01	H9047_049_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	049	0	1	01	01	H9047_049_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	049	0	1	01	01	H9047_049_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	054	0	1	01	01	H9047_054_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	054	0	1	01	01	H9047_054_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	054	0	1	01	01	H9047_054_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	054	0	1	01	01	H9047_054_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	054	0	1	01	01	H9047_054_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	055	1	1	01	01	H9047_055_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	055	1	1	01	01	H9047_055_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	055	1	1	01	01	H9047_055_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	055	1	1	01	01	H9047_055_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	055	1	1	01	01	H9047_055_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	055	2	1	01	01	H9047_055_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	055	2	1	01	01	H9047_055_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	055	2	1	01	01	H9047_055_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	055	2	1	01	01	H9047_055_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	055	2	1	01	01	H9047_055_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	056	1	1	02	01	H9047_056_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	056	1	1	02	01	H9047_056_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	056	1	1	02	01	H9047_056_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	056	1	1	02	01	H9047_056_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	056	1	1	02	01	H9047_056_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	056	2	1	02	01	H9047_056_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	056	2	1	02	01	H9047_056_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	056	2	1	02	01	H9047_056_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	056	2	1	02	01	H9047_056_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	056	2	1	02	01	H9047_056_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	059	0	1	02	01	H9047_059_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	059	0	1	02	01	H9047_059_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	059	0	1	02	01	H9047_059_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	059	0	1	02	01	H9047_059_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	059	0	1	02	01	H9047_059_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	060	0	1	02	01	H9047_060_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	060	0	1	02	01	H9047_060_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	060	0	1	02	01	H9047_060_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	060	0	1	02	01	H9047_060_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	060	0	1	02	01	H9047_060_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	062	0	1	02	01	H9047_062_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	062	0	1	02	01	H9047_062_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	062	0	1	02	01	H9047_062_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	062	0	1	02	01	H9047_062_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	062	0	1	02	01	H9047_062_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9047	063	0	1	01	01	H9047_063_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9047	063	0	1	01	01	H9047_063_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9047	063	0	1	01	01	H9047_063_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9047	063	0	1	01	01	H9047_063_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9047	063	0	1	01	01	H9047_063_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9065	001	0	1	01	01	H9065_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H9065	001	0	1	01	01	H9065_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9065	001	0	1	01	01	H9065_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9065	001	0	1	01	01	H9065_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9065	001	0	1	01	01	H9065_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9065	001	0	1	01	01	H9065_001_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9065	002	0	1	02	01	H9065_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H9065	002	0	1	02	01	H9065_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9065	002	0	1	02	01	H9065_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9065	002	0	1	02	01	H9065_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9065	002	0	1	02	01	H9065_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9065	002	0	1	02	01	H9065_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9065	003	0	1	02	01	H9065_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H9065	003	0	1	02	01	H9065_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9065	003	0	1	02	01	H9065_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9065	003	0	1	02	01	H9065_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9065	003	0	1	02	01	H9065_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9065	003	0	1	02	01	H9065_003_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9065	004	0	1	02	01	H9065_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9065	004	0	1	02	01	H9065_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9065	004	0	1	02	01	H9065_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9065	004	0	1	02	01	H9065_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9065	004	0	1	02	01	H9065_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9065	004	0	1	02	01	H9065_004_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9065	005	0	1	01	01	H9065_005_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9065	005	0	1	01	01	H9065_005_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9065	005	0	1	01	01	H9065_005_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9065	005	0	1	01	01	H9065_005_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9065	005	0	1	01	01	H9065_005_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9065	005	0	1	01	01	H9065_005_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9065	006	0	1	01	01	H9065_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9065	006	0	1	01	01	H9065_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9065	006	0	1	01	01	H9065_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9065	006	0	1	01	01	H9065_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9065	006	0	1	01	01	H9065_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9065	006	0	1	01	01	H9065_006_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9065	007	0	1	01	01	H9065_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9065	007	0	1	01	01	H9065_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9065	007	0	1	01	01	H9065_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9065	007	0	1	01	01	H9065_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9065	007	0	1	01	01	H9065_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9065	007	0	1	01	01	H9065_007_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9065	008	0	1	01	01	H9065_008_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H9065	008	0	1	01	01	H9065_008_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9065	008	0	1	01	01	H9065_008_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9065	008	0	1	01	01	H9065_008_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9065	008	0	1	01	01	H9065_008_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9065	008	0	1	01	01	H9065_008_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9070	002	0	1	04	01	H9070_002_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9070	002	0	1	04	01	H9070_002_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9070	002	0	1	04	01	H9070_002_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9070	002	0	1	04	01	H9070_002_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9070	002	0	1	04	01	H9070_002_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9070	003	0	1	04	01	H9070_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9070	003	0	1	04	01	H9070_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H9070	003	0	1	04	01	H9070_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9070	003	0	1	04	01	H9070_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9070	003	0	1	04	01	H9070_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9070	004	0	1	04	01	H9070_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9070	004	0	1	04	01	H9070_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9070	004	0	1	04	01	H9070_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9070	004	0	1	04	01	H9070_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9070	004	0	1	04	01	H9070_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9070	005	0	1	04	01	H9070_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9070	005	0	1	04	01	H9070_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9070	005	0	1	04	01	H9070_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9070	005	0	1	04	01	H9070_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9070	005	0	1	04	01	H9070_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9070	006	1	1	04	01	H9070_006_1	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9070	006	1	1	04	01	H9070_006_1	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H9070	006	1	1	04	01	H9070_006_1	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9070	006	1	1	04	01	H9070_006_1	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9070	006	1	1	04	01	H9070_006_1	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9070	006	2	1	04	01	H9070_006_2	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9070	006	2	1	04	01	H9070_006_2	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H9070	006	2	1	04	01	H9070_006_2	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9070	006	2	1	04	01	H9070_006_2	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9070	006	2	1	04	01	H9070_006_2	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9070	006	3	1	04	01	H9070_006_3	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9070	006	3	1	04	01	H9070_006_3	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
H9070	006	3	1	04	01	H9070_006_3	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9070	006	3	1	04	01	H9070_006_3	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9070	006	3	1	04	01	H9070_006_3	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9082	009	0	1	01	01	H9082_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9082	009	0	1	01	01	H9082_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9082	009	0	1	01	01	H9082_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9082	009	0	1	01	01	H9082_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9082	009	0	1	01	01	H9082_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9096	001	0	1	02	01	H9096_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H9096	001	0	1	02	01	H9096_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H9096	001	0	1	02	01	H9096_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	11	1						
H9096	001	0	1	02	01	H9096_001_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H9096	001	0	1	02	01	H9096_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H9096	001	0	1	02	01	H9096_001_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H9096	002	0	1	02	01	H9096_002_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H9096	002	0	1	02	01	H9096_002_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H9096	002	0	1	02	01	H9096_002_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	11	1						
H9096	002	0	1	02	01	H9096_002_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H9096	002	0	1	02	01	H9096_002_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H9096	002	0	1	02	01	H9096_002_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H9096	004	0	1	01	01	H9096_004_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H9096	004	0	1	01	01	H9096_004_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H9096	004	0	1	01	01	H9096_004_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	11	1						
H9096	004	0	1	01	01	H9096_004_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H9096	004	0	1	01	01	H9096_004_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H9096	004	0	1	01	01	H9096_004_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H9096	005	0	1	01	01	H9096_005_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H9096	005	0	1	01	01	H9096_005_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H9096	005	0	1	01	01	H9096_005_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	11	1						
H9096	005	0	1	01	01	H9096_005_0	7	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H9096	005	0	1	01	01	H9096_005_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H9096	005	0	1	01	01	H9096_005_0	7	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H9096	006	0	1	02	01	H9096_006_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H9096	006	0	1	02	01	H9096_006_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H9096	006	0	1	02	01	H9096_006_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	11	1						
H9096	006	0	1	02	01	H9096_006_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H9096	006	0	1	02	01	H9096_006_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H9096	006	0	1	02	01	H9096_006_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H9096	009	0	1	02	01	H9096_009_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	1	2	01	1						
H9096	009	0	1	02	01	H9096_009_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	2	2	01	1						
H9096	009	0	1	02	01	H9096_009_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	3	2	11	1						
H9096	009	0	1	02	01	H9096_009_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	4	2	11	1						
H9096	009	0	1	02	01	H9096_009_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	5	2	11	1						
H9096	009	0	1	02	01	H9096_009_0	8	Vaccines	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines	6	2	11	1						
H9104	006	0	1	01	01	H9104_006_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9104	006	0	1	01	01	H9104_006_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9104	006	0	1	01	01	H9104_006_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9104	006	0	1	01	01	H9104_006_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9104	006	0	1	01	01	H9104_006_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9147	001	0	1	01	01	H9147_001_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9147	001	0	1	01	01	H9147_001_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9147	001	0	1	01	01	H9147_001_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9147	001	0	1	01	01	H9147_001_0	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9147	001	0	1	01	01	H9147_001_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9147	001	0	1	01	01	H9147_001_0	7	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9207	002	0	1	02	01	H9207_002_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9207	002	0	1	02	01	H9207_002_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9207	002	0	1	02	01	H9207_002_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H9207	002	0	1	02	01	H9207_002_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9207	002	0	1	02	01	H9207_002_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9207	012	0	1	02	01	H9207_012_0	12	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9207	012	0	1	02	01	H9207_012_0	12	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9207	012	0	1	02	01	H9207_012_0	12	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H9207	012	0	1	02	01	H9207_012_0	12	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9207	012	0	1	02	01	H9207_012_0	12	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9219	001	0	1	04	01	H9219_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H9219	001	0	1	04	01	H9219_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9219	001	0	1	04	01	H9219_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9219	001	0	1	04	01	H9219_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9219	001	0	1	04	01	H9219_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9219	001	0	1	04	01	H9219_001_0	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9219	002	0	1	04	01	H9219_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	3						
H9219	002	0	1	04	01	H9219_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9219	002	0	1	04	01	H9219_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9219	002	0	1	04	01	H9219_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9219	002	0	1	04	01	H9219_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9219	002	0	1	04	01	H9219_002_0	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9258	001	0	1	01	01	H9258_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9258	001	0	1	01	01	H9258_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9258	001	0	1	01	01	H9258_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9258	001	0	1	01	01	H9258_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9258	001	0	1	01	01	H9258_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9276	021	0	1	01	01	H9276_021_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9276	021	0	1	01	01	H9276_021_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9276	021	0	1	01	01	H9276_021_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9276	021	0	1	01	01	H9276_021_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9276	021	0	1	01	01	H9276_021_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9276	021	0	1	01	01	H9276_021_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9302	003	0	1	01	01	H9302_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9302	003	0	1	01	01	H9302_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9302	003	0	1	01	01	H9302_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9302	003	0	1	01	01	H9302_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9302	003	0	1	01	01	H9302_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9302	007	0	1	01	01	H9302_007_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9302	007	0	1	01	01	H9302_007_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9302	007	0	1	01	01	H9302_007_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9302	007	0	1	01	01	H9302_007_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9302	007	0	1	01	01	H9302_007_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9302	011	0	1	01	01	H9302_011_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9302	011	0	1	01	01	H9302_011_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9302	011	0	1	01	01	H9302_011_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9302	011	0	1	01	01	H9302_011_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9302	011	0	1	01	01	H9302_011_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9335	001	0	1	01	01	H9335_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9335	001	0	1	01	01	H9335_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9335	001	0	1	01	01	H9335_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9335	001	0	1	01	01	H9335_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9335	001	0	1	01	01	H9335_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9335	002	0	1	01	01	H9335_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9335	002	0	1	01	01	H9335_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9335	002	0	1	01	01	H9335_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9335	002	0	1	01	01	H9335_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9335	002	0	1	01	01	H9335_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9335	003	0	1	01	01	H9335_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9335	003	0	1	01	01	H9335_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9335	003	0	1	01	01	H9335_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9335	003	0	1	01	01	H9335_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9335	003	0	1	01	01	H9335_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9335	005	0	1	01	01	H9335_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9335	005	0	1	01	01	H9335_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9335	005	0	1	01	01	H9335_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9335	005	0	1	01	01	H9335_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9335	005	0	1	01	01	H9335_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9335	006	0	1	01	01	H9335_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9335	006	0	1	01	01	H9335_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9335	006	0	1	01	01	H9335_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9335	006	0	1	01	01	H9335_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9335	006	0	1	01	01	H9335_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9364	001	0	1	01	01	H9364_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9364	001	0	1	01	01	H9364_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9364	001	0	1	01	01	H9364_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9364	001	0	1	01	01	H9364_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9364	001	0	1	01	01	H9364_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9364	002	0	1	01	01	H9364_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9364	002	0	1	01	01	H9364_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9364	002	0	1	01	01	H9364_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9364	002	0	1	01	01	H9364_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9364	002	0	1	01	01	H9364_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9364	003	0	1	01	01	H9364_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9364	003	0	1	01	01	H9364_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9364	003	0	1	01	01	H9364_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9364	003	0	1	01	01	H9364_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9364	003	0	1	01	01	H9364_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9387	001	0	1	04	01	H9387_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9387	001	0	1	04	01	H9387_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9387	001	0	1	04	01	H9387_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9387	001	0	1	04	01	H9387_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9387	001	0	1	04	01	H9387_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9387	001	0	1	04	01	H9387_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9403	003	0	1	01	01	H9403_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9403	003	0	1	01	01	H9403_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9403	003	0	1	01	01	H9403_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H9403	003	0	1	01	01	H9403_003_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H9403	003	0	1	01	01	H9403_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9403	004	0	1	01	01	H9403_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9403	004	0	1	01	01	H9403_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9403	004	0	1	01	01	H9403_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9403	004	0	1	01	01	H9403_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9403	004	0	1	01	01	H9403_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9408	005	0	1	04	01	H9408_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9408	005	0	1	04	01	H9408_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9408	005	0	1	04	01	H9408_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H9408	005	0	1	04	01	H9408_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9408	005	0	1	04	01	H9408_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9408	005	0	1	04	01	H9408_005_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9408	006	1	1	04	01	H9408_006_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9408	006	1	1	04	01	H9408_006_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9408	006	1	1	04	01	H9408_006_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H9408	006	1	1	04	01	H9408_006_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9408	006	1	1	04	01	H9408_006_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9408	006	1	1	04	01	H9408_006_1	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9408	006	2	1	04	01	H9408_006_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9408	006	2	1	04	01	H9408_006_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9408	006	2	1	04	01	H9408_006_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
H9408	006	2	1	04	01	H9408_006_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9408	006	2	1	04	01	H9408_006_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9408	006	2	1	04	01	H9408_006_2	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9428	001	0	1	04	01	H9428_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9428	001	0	1	04	01	H9428_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9428	001	0	1	04	01	H9428_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9428	001	0	1	04	01	H9428_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9428	001	0	1	04	01	H9428_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9428	002	0	1	04	01	H9428_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9428	002	0	1	04	01	H9428_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9428	002	0	1	04	01	H9428_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9428	002	0	1	04	01	H9428_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9428	002	0	1	04	01	H9428_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	001	0	1	04	01	H9431_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	001	0	1	04	01	H9431_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	001	0	1	04	01	H9431_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	001	0	1	04	01	H9431_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	001	0	1	04	01	H9431_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	002	0	1	04	01	H9431_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	002	0	1	04	01	H9431_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	002	0	1	04	01	H9431_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	002	0	1	04	01	H9431_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	002	0	1	04	01	H9431_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	003	0	1	04	01	H9431_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	003	0	1	04	01	H9431_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	003	0	1	04	01	H9431_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	003	0	1	04	01	H9431_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	003	0	1	04	01	H9431_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	004	0	1	04	01	H9431_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	004	0	1	04	01	H9431_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	004	0	1	04	01	H9431_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	004	0	1	04	01	H9431_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	004	0	1	04	01	H9431_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	005	0	1	04	01	H9431_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	005	0	1	04	01	H9431_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	005	0	1	04	01	H9431_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	005	0	1	04	01	H9431_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	005	0	1	04	01	H9431_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	006	0	1	04	01	H9431_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	006	0	1	04	01	H9431_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	006	0	1	04	01	H9431_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	006	0	1	04	01	H9431_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	006	0	1	04	01	H9431_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	007	0	1	04	01	H9431_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	007	0	1	04	01	H9431_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	007	0	1	04	01	H9431_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	007	0	1	04	01	H9431_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	007	0	1	04	01	H9431_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	008	0	1	04	01	H9431_008_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	008	0	1	04	01	H9431_008_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	008	0	1	04	01	H9431_008_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	008	0	1	04	01	H9431_008_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	008	0	1	04	01	H9431_008_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	009	0	1	04	01	H9431_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	009	0	1	04	01	H9431_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	009	0	1	04	01	H9431_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	009	0	1	04	01	H9431_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	009	0	1	04	01	H9431_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	011	0	1	04	01	H9431_011_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	011	0	1	04	01	H9431_011_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	011	0	1	04	01	H9431_011_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	011	0	1	04	01	H9431_011_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	011	0	1	04	01	H9431_011_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	013	0	1	04	01	H9431_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	013	0	1	04	01	H9431_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	013	0	1	04	01	H9431_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	013	0	1	04	01	H9431_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	013	0	1	04	01	H9431_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9431	014	0	1	04	01	H9431_014_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9431	014	0	1	04	01	H9431_014_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9431	014	0	1	04	01	H9431_014_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9431	014	0	1	04	01	H9431_014_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9431	014	0	1	04	01	H9431_014_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9460	001	0	1	01	01	H9460_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9460	001	0	1	01	01	H9460_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9460	001	0	1	01	01	H9460_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9460	001	0	1	01	01	H9460_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9460	001	0	1	01	01	H9460_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9487	001	0	1	48	05	H9487_001_0	2	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H9487	001	0	1	48	05	H9487_001_0	2	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H9487	001	0	1	48	05	H9487_001_0	2	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H9489	001	0	1	01	01	H9489_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9489	001	0	1	01	01	H9489_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9489	001	0	1	01	01	H9489_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9489	001	0	1	01	01	H9489_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9489	001	0	1	01	01	H9489_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9516	001	0	1	04	01	H9516_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9516	001	0	1	04	01	H9516_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H9516	001	0	1	04	01	H9516_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9516	001	0	1	04	01	H9516_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9516	001	0	1	04	01	H9516_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9516	001	0	1	04	01	H9516_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H9516	002	0	1	04	01	H9516_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9516	002	0	1	04	01	H9516_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H9516	002	0	1	04	01	H9516_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9516	002	0	1	04	01	H9516_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9516	002	0	1	04	01	H9516_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9516	002	0	1	04	01	H9516_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H9525	003	0	1	01	01	H9525_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9525	003	0	1	01	01	H9525_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9525	003	0	1	01	01	H9525_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9525	003	0	1	01	01	H9525_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9525	003	0	1	01	01	H9525_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9525	003	0	1	01	01	H9525_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9525	004	0	1	01	01	H9525_004_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9525	004	0	1	01	01	H9525_004_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9525	004	0	1	01	01	H9525_004_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9525	004	0	1	01	01	H9525_004_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9525	004	0	1	01	01	H9525_004_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9525	004	0	1	01	01	H9525_004_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9525	006	0	1	01	01	H9525_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9525	006	0	1	01	01	H9525_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9525	006	0	1	01	01	H9525_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9525	006	0	1	01	01	H9525_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9525	006	0	1	01	01	H9525_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9525	006	0	1	01	01	H9525_006_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9525	007	0	1	01	01	H9525_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9525	007	0	1	01	01	H9525_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9525	007	0	1	01	01	H9525_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9525	007	0	1	01	01	H9525_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9525	007	0	1	01	01	H9525_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9525	007	0	1	01	01	H9525_007_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9525	008	0	1	01	01	H9525_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9525	008	0	1	01	01	H9525_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9525	008	0	1	01	01	H9525_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9525	008	0	1	01	01	H9525_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9525	008	0	1	01	01	H9525_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9525	008	0	1	01	01	H9525_008_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	001	1	1	04	01	H9572_001_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	001	1	1	04	01	H9572_001_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	001	1	1	04	01	H9572_001_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	001	1	1	04	01	H9572_001_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	001	1	1	04	01	H9572_001_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	001	1	1	04	01	H9572_001_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	001	2	1	04	01	H9572_001_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	001	2	1	04	01	H9572_001_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	001	2	1	04	01	H9572_001_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	001	2	1	04	01	H9572_001_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	001	2	1	04	01	H9572_001_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	001	2	1	04	01	H9572_001_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	001	3	1	04	01	H9572_001_3	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	001	3	1	04	01	H9572_001_3	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	001	3	1	04	01	H9572_001_3	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	001	3	1	04	01	H9572_001_3	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	001	3	1	04	01	H9572_001_3	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	001	3	1	04	01	H9572_001_3	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	001	4	1	04	01	H9572_001_4	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	001	4	1	04	01	H9572_001_4	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	001	4	1	04	01	H9572_001_4	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	001	4	1	04	01	H9572_001_4	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	001	4	1	04	01	H9572_001_4	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	001	4	1	04	01	H9572_001_4	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	001	6	1	04	01	H9572_001_6	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	001	6	1	04	01	H9572_001_6	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	001	6	1	04	01	H9572_001_6	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	001	6	1	04	01	H9572_001_6	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	001	6	1	04	01	H9572_001_6	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	001	6	1	04	01	H9572_001_6	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	002	1	1	04	01	H9572_002_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	002	1	1	04	01	H9572_002_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	002	1	1	04	01	H9572_002_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	002	1	1	04	01	H9572_002_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	002	1	1	04	01	H9572_002_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	002	1	1	04	01	H9572_002_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	002	2	1	04	01	H9572_002_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	002	2	1	04	01	H9572_002_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	002	2	1	04	01	H9572_002_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	002	2	1	04	01	H9572_002_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	002	2	1	04	01	H9572_002_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	002	2	1	04	01	H9572_002_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	002	3	1	04	01	H9572_002_3	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	002	3	1	04	01	H9572_002_3	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	002	3	1	04	01	H9572_002_3	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	002	3	1	04	01	H9572_002_3	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	002	3	1	04	01	H9572_002_3	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	002	3	1	04	01	H9572_002_3	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	002	4	1	04	01	H9572_002_4	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	002	4	1	04	01	H9572_002_4	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	002	4	1	04	01	H9572_002_4	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	002	4	1	04	01	H9572_002_4	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	002	4	1	04	01	H9572_002_4	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	002	4	1	04	01	H9572_002_4	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	002	6	1	04	01	H9572_002_6	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	002	6	1	04	01	H9572_002_6	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	002	6	1	04	01	H9572_002_6	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	002	6	1	04	01	H9572_002_6	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	002	6	1	04	01	H9572_002_6	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	002	6	1	04	01	H9572_002_6	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	003	1	1	04	01	H9572_003_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	003	1	1	04	01	H9572_003_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	003	1	1	04	01	H9572_003_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	003	1	1	04	01	H9572_003_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	003	1	1	04	01	H9572_003_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	003	1	1	04	01	H9572_003_1	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	003	2	1	04	01	H9572_003_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	003	2	1	04	01	H9572_003_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	003	2	1	04	01	H9572_003_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	003	2	1	04	01	H9572_003_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	003	2	1	04	01	H9572_003_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	003	2	1	04	01	H9572_003_2	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	003	3	1	04	01	H9572_003_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	003	3	1	04	01	H9572_003_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	003	3	1	04	01	H9572_003_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	003	3	1	04	01	H9572_003_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	003	3	1	04	01	H9572_003_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	003	3	1	04	01	H9572_003_3	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	003	4	1	04	01	H9572_003_4	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	003	4	1	04	01	H9572_003_4	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	003	4	1	04	01	H9572_003_4	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	003	4	1	04	01	H9572_003_4	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	003	4	1	04	01	H9572_003_4	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	003	4	1	04	01	H9572_003_4	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	003	6	1	04	01	H9572_003_6	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	003	6	1	04	01	H9572_003_6	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	003	6	1	04	01	H9572_003_6	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	003	6	1	04	01	H9572_003_6	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	003	6	1	04	01	H9572_003_6	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	003	6	1	04	01	H9572_003_6	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	004	1	1	04	01	H9572_004_1	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	004	1	1	04	01	H9572_004_1	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	004	1	1	04	01	H9572_004_1	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	004	1	1	04	01	H9572_004_1	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	004	1	1	04	01	H9572_004_1	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	004	1	1	04	01	H9572_004_1	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	004	2	1	04	01	H9572_004_2	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	004	2	1	04	01	H9572_004_2	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	004	2	1	04	01	H9572_004_2	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	004	2	1	04	01	H9572_004_2	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	004	2	1	04	01	H9572_004_2	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	004	2	1	04	01	H9572_004_2	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	004	3	1	04	01	H9572_004_3	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	004	3	1	04	01	H9572_004_3	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	004	3	1	04	01	H9572_004_3	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	004	3	1	04	01	H9572_004_3	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	004	3	1	04	01	H9572_004_3	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	004	3	1	04	01	H9572_004_3	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	004	4	1	04	01	H9572_004_4	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	004	4	1	04	01	H9572_004_4	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	004	4	1	04	01	H9572_004_4	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	004	4	1	04	01	H9572_004_4	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	004	4	1	04	01	H9572_004_4	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	004	4	1	04	01	H9572_004_4	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9572	004	6	1	04	01	H9572_004_6	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9572	004	6	1	04	01	H9572_004_6	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9572	004	6	1	04	01	H9572_004_6	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9572	004	6	1	04	01	H9572_004_6	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9572	004	6	1	04	01	H9572_004_6	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9572	004	6	1	04	01	H9572_004_6	7	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9576	001	0	1	48	05	H9576_001_0	4	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H9576	001	0	1	48	05	H9576_001_0	4	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H9576	001	0	1	48	05	H9576_001_0	4	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H9589	003	0	1	04	01	H9589_003_0	13	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9589	003	0	1	04	01	H9589_003_0	13	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9589	003	0	1	04	01	H9589_003_0	13	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H9589	003	0	1	04	01	H9589_003_0	13	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H9589	003	0	1	04	01	H9589_003_0	13	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9615	007	0	1	04	01	H9615_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9615	007	0	1	04	01	H9615_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9615	007	0	1	04	01	H9615_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9615	007	0	1	04	01	H9615_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9615	007	0	1	04	01	H9615_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9615	008	0	1	04	01	H9615_008_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9615	008	0	1	04	01	H9615_008_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9615	008	0	1	04	01	H9615_008_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9615	008	0	1	04	01	H9615_008_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9615	008	0	1	04	01	H9615_008_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9615	009	0	1	04	01	H9615_009_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9615	009	0	1	04	01	H9615_009_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9615	009	0	1	04	01	H9615_009_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9615	009	0	1	04	01	H9615_009_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9615	009	0	1	04	01	H9615_009_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9615	010	0	1	04	01	H9615_010_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9615	010	0	1	04	01	H9615_010_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9615	010	0	1	04	01	H9615_010_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9615	010	0	1	04	01	H9615_010_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9615	010	0	1	04	01	H9615_010_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9615	012	0	1	04	01	H9615_012_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9615	012	0	1	04	01	H9615_012_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9615	012	0	1	04	01	H9615_012_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9615	012	0	1	04	01	H9615_012_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9615	012	0	1	04	01	H9615_012_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9615	014	0	1	04	01	H9615_014_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9615	014	0	1	04	01	H9615_014_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9615	014	0	1	04	01	H9615_014_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9615	014	0	1	04	01	H9615_014_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9615	014	0	1	04	01	H9615_014_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9630	001	0	1	01	01	H9630_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9630	001	0	1	01	01	H9630_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9630	001	0	1	01	01	H9630_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9630	001	0	1	01	01	H9630_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9630	001	0	1	01	01	H9630_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9630	001	0	1	01	01	H9630_001_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9630	002	0	1	01	01	H9630_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9630	002	0	1	01	01	H9630_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9630	002	0	1	01	01	H9630_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9630	002	0	1	01	01	H9630_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9630	002	0	1	01	01	H9630_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9630	002	0	1	01	01	H9630_002_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9630	003	0	1	01	01	H9630_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9630	003	0	1	01	01	H9630_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9630	003	0	1	01	01	H9630_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9630	003	0	1	01	01	H9630_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9630	003	0	1	01	01	H9630_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9630	003	0	1	01	01	H9630_003_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9630	004	0	1	01	01	H9630_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9630	004	0	1	01	01	H9630_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9630	004	0	1	01	01	H9630_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9630	004	0	1	01	01	H9630_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9630	004	0	1	01	01	H9630_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9630	004	0	1	01	01	H9630_004_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9630	005	0	1	01	01	H9630_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9630	005	0	1	01	01	H9630_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9630	005	0	1	01	01	H9630_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9630	005	0	1	01	01	H9630_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9630	005	0	1	01	01	H9630_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9630	005	0	1	01	01	H9630_005_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9630	006	0	1	01	01	H9630_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9630	006	0	1	01	01	H9630_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9630	006	0	1	01	01	H9630_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9630	006	0	1	01	01	H9630_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9630	006	0	1	01	01	H9630_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9630	006	0	1	01	01	H9630_006_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9630	008	0	1	01	01	H9630_008_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9630	008	0	1	01	01	H9630_008_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9630	008	0	1	01	01	H9630_008_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9630	008	0	1	01	01	H9630_008_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9630	008	0	1	01	01	H9630_008_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9630	008	0	1	01	01	H9630_008_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9686	001	0	1	01	01	H9686_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9686	001	0	1	01	01	H9686_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H9686	001	0	1	01	01	H9686_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9686	001	0	1	01	01	H9686_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H9686	001	0	1	01	01	H9686_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9686	001	0	1	01	01	H9686_001_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9686	002	0	1	01	01	H9686_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9686	002	0	1	01	01	H9686_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9686	002	0	1	01	01	H9686_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9686	002	0	1	01	01	H9686_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9686	002	0	1	01	01	H9686_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9686	002	0	1	01	01	H9686_002_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9686	003	0	1	01	01	H9686_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9686	003	0	1	01	01	H9686_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	3						
H9686	003	0	1	01	01	H9686_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9686	003	0	1	01	01	H9686_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	3						
H9686	003	0	1	01	01	H9686_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9686	003	0	1	01	01	H9686_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9699	004	1	1	01	01	H9699_004_1	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9699	004	1	1	01	01	H9699_004_1	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9699	004	1	1	01	01	H9699_004_1	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9699	004	1	1	01	01	H9699_004_1	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9699	004	1	1	01	01	H9699_004_1	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9699	004	1	1	01	01	H9699_004_1	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9699	004	2	1	01	01	H9699_004_2	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9699	004	2	1	01	01	H9699_004_2	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9699	004	2	1	01	01	H9699_004_2	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9699	004	2	1	01	01	H9699_004_2	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9699	004	2	1	01	01	H9699_004_2	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9699	004	2	1	01	01	H9699_004_2	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9699	004	3	1	01	01	H9699_004_3	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9699	004	3	1	01	01	H9699_004_3	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9699	004	3	1	01	01	H9699_004_3	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9699	004	3	1	01	01	H9699_004_3	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9699	004	3	1	01	01	H9699_004_3	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9699	004	3	1	01	01	H9699_004_3	6	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
H9699	006	0	1	01	01	H9699_006_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9699	006	0	1	01	01	H9699_006_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9699	006	0	1	01	01	H9699_006_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9699	006	0	1	01	01	H9699_006_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9699	006	0	1	01	01	H9699_006_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9699	006	0	1	01	01	H9699_006_0	9	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	3						
H9706	001	0	1	01	01	H9706_001_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9706	001	0	1	01	01	H9706_001_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9706	001	0	1	01	01	H9706_001_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9706	001	0	1	01	01	H9706_001_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9706	001	0	1	01	01	H9706_001_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9706	003	0	1	01	01	H9706_003_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9706	003	0	1	01	01	H9706_003_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9706	003	0	1	01	01	H9706_003_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9706	003	0	1	01	01	H9706_003_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9706	003	0	1	01	01	H9706_003_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9712	001	0	1	48	05	H9712_001_0	4	Generic Drugs	4	Generic Drugs, Brand Drugs	1	2	01					3	0.00	0.00
H9712	001	0	1	48	05	H9712_001_0	4	Brand Drugs	4	Generic Drugs, Brand Drugs	2	2	10					3	0.00	0.00
H9725	001	0	1	01	01	H9725_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9725	001	0	1	01	01	H9725_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9725	001	0	1	01	01	H9725_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9725	001	0	1	01	01	H9725_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9725	001	0	1	01	01	H9725_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9725	006	0	1	01	01	H9725_006_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9725	006	0	1	01	01	H9725_006_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9725	006	0	1	01	01	H9725_006_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9725	006	0	1	01	01	H9725_006_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9725	006	0	1	01	01	H9725_006_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9730	002	0	1	01	01	H9730_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9730	002	0	1	01	01	H9730_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9730	002	0	1	01	01	H9730_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9730	002	0	1	01	01	H9730_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9730	002	0	1	01	01	H9730_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9730	003	0	1	01	01	H9730_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9730	003	0	1	01	01	H9730_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9730	003	0	1	01	01	H9730_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9730	003	0	1	01	01	H9730_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9730	003	0	1	01	01	H9730_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9730	004	0	1	01	01	H9730_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9730	004	0	1	01	01	H9730_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9730	004	0	1	01	01	H9730_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9730	004	0	1	01	01	H9730_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9730	004	0	1	01	01	H9730_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9730	005	0	1	02	01	H9730_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9730	005	0	1	02	01	H9730_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9730	005	0	1	02	01	H9730_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9730	005	0	1	02	01	H9730_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9730	005	0	1	02	01	H9730_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9730	007	0	1	01	01	H9730_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9730	007	0	1	01	01	H9730_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9730	007	0	1	01	01	H9730_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9730	007	0	1	01	01	H9730_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9730	007	0	1	01	01	H9730_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9730	009	0	1	01	01	H9730_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9730	009	0	1	01	01	H9730_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9730	009	0	1	01	01	H9730_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9730	009	0	1	01	01	H9730_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9730	009	0	1	01	01	H9730_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9730	010	0	1	01	01	H9730_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
H9730	010	0	1	01	01	H9730_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9730	010	0	1	01	01	H9730_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9730	010	0	1	01	01	H9730_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9730	010	0	1	01	01	H9730_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9808	004	0	1	04	01	H9808_004_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9808	004	0	1	04	01	H9808_004_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9808	004	0	1	04	01	H9808_004_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9808	004	0	1	04	01	H9808_004_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9808	004	0	1	04	01	H9808_004_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9808	005	0	1	04	01	H9808_005_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9808	005	0	1	04	01	H9808_005_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9808	005	0	1	04	01	H9808_005_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9808	005	0	1	04	01	H9808_005_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9808	005	0	1	04	01	H9808_005_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9811	001	0	1	01	01	H9811_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9811	001	0	1	01	01	H9811_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9811	001	0	1	01	01	H9811_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9811	001	0	1	01	01	H9811_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9811	001	0	1	01	01	H9811_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9811	001	0	1	01	01	H9811_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9811	005	0	1	01	01	H9811_005_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9811	005	0	1	01	01	H9811_005_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9811	005	0	1	01	01	H9811_005_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9811	005	0	1	01	01	H9811_005_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9811	005	0	1	01	01	H9811_005_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9811	005	0	1	01	01	H9811_005_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9811	006	0	1	01	01	H9811_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9811	006	0	1	01	01	H9811_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9811	006	0	1	01	01	H9811_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9811	006	0	1	01	01	H9811_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9811	006	0	1	01	01	H9811_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9811	007	0	1	01	01	H9811_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9811	007	0	1	01	01	H9811_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9811	007	0	1	01	01	H9811_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9811	007	0	1	01	01	H9811_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9811	007	0	1	01	01	H9811_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9811	008	0	1	01	01	H9811_008_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
H9811	008	0	1	01	01	H9811_008_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
H9811	008	0	1	01	01	H9811_008_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9811	008	0	1	01	01	H9811_008_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9811	008	0	1	01	01	H9811_008_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9811	008	0	1	01	01	H9811_008_0	4	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
H9811	009	0	1	01	01	H9811_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9811	009	0	1	01	01	H9811_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9811	009	0	1	01	01	H9811_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9811	009	0	1	01	01	H9811_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9811	009	0	1	01	01	H9811_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9834	001	0	1	01	01	H9834_001_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9834	001	0	1	01	01	H9834_001_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9834	001	0	1	01	01	H9834_001_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H9834	001	0	1	01	01	H9834_001_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9834	001	0	1	01	01	H9834_001_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9834	003	0	1	01	01	H9834_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9834	003	0	1	01	01	H9834_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9834	003	0	1	01	01	H9834_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H9834	003	0	1	01	01	H9834_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9834	003	0	1	01	01	H9834_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9834	006	0	1	01	01	H9834_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9834	006	0	1	01	01	H9834_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9834	006	0	1	01	01	H9834_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H9834	006	0	1	01	01	H9834_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9834	006	0	1	01	01	H9834_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9861	001	0	1	01	01	H9861_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9861	001	0	1	01	01	H9861_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9861	001	0	1	01	01	H9861_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H9861	001	0	1	01	01	H9861_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H9861	001	0	1	01	01	H9861_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9861	002	0	1	01	01	H9861_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
H9861	002	0	1	01	01	H9861_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
H9861	002	0	1	01	01	H9861_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
H9861	002	0	1	01	01	H9861_002_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
H9861	002	0	1	01	01	H9861_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
H9869	001	0	1	48	05	H9869_001_0	4	Generic Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	2	01					1	0.00	0.00
H9869	001	0	1	48	05	H9869_001_0	4	Brand Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	2	10					1	0.00	0.00
H9869	001	0	1	48	05	H9869_001_0	4	Non-Medicare Rx/OTC Drugs	4	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	3	2	11					2	0.00	0.00
H9878	001	0	1	04	01	H9878_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9878	001	0	1	04	01	H9878_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H9878	001	0	1	04	01	H9878_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9878	001	0	1	04	01	H9878_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9878	001	0	1	04	01	H9878_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9878	001	0	1	04	01	H9878_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H9878	002	0	1	04	01	H9878_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9878	002	0	1	04	01	H9878_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H9878	002	0	1	04	01	H9878_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9878	002	0	1	04	01	H9878_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9878	002	0	1	04	01	H9878_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9878	002	0	1	04	01	H9878_002_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H9878	003	0	1	04	01	H9878_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9878	003	0	1	04	01	H9878_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H9878	003	0	1	04	01	H9878_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9878	003	0	1	04	01	H9878_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9878	003	0	1	04	01	H9878_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9878	003	0	1	04	01	H9878_003_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H9878	006	0	1	04	01	H9878_006_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9878	006	0	1	04	01	H9878_006_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H9878	006	0	1	04	01	H9878_006_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9878	006	0	1	04	01	H9878_006_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9878	006	0	1	04	01	H9878_006_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9878	006	0	1	04	01	H9878_006_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H9878	008	0	1	04	01	H9878_008_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9878	008	0	1	04	01	H9878_008_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H9878	008	0	1	04	01	H9878_008_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9878	008	0	1	04	01	H9878_008_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9878	008	0	1	04	01	H9878_008_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9878	008	0	1	04	01	H9878_008_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H9878	009	0	1	04	01	H9878_009_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	11	1						
H9878	009	0	1	04	01	H9878_009_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	11	1						
H9878	009	0	1	04	01	H9878_009_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
H9878	009	0	1	04	01	H9878_009_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
H9878	009	0	1	04	01	H9878_009_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
H9878	009	0	1	04	01	H9878_009_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	3						
H9917	001	0	1	01	01	H9917_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H9917	001	0	1	01	01	H9917_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H9917	001	0	1	01	01	H9917_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H9917	001	0	1	01	01	H9917_001_0	4	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H9917	001	0	1	01	01	H9917_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H9917	002	0	1	01	01	H9917_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
H9917	002	0	1	01	01	H9917_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
H9917	002	0	1	01	01	H9917_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
H9917	002	0	1	01	01	H9917_002_0	5	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
H9917	002	0	1	01	01	H9917_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
H9955	001	0	1	01	01	H9955_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
H9955	001	0	1	01	01	H9955_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
H9955	001	0	1	01	01	H9955_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
H9955	001	0	1	01	01	H9955_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
H9955	001	0	1	01	01	H9955_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R0110	003	0	1	31	11	R0110_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R0110	003	0	1	31	11	R0110_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R0110	003	0	1	31	11	R0110_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R0110	003	0	1	31	11	R0110_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R0110	003	0	1	31	11	R0110_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R0759	001	0	1	31	11	R0759_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R0759	001	0	1	31	11	R0759_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R0759	001	0	1	31	11	R0759_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R0759	001	0	1	31	11	R0759_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R0759	001	0	1	31	11	R0759_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R0802	001	0	1	31	11	R0802_001_0	10	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R0802	001	0	1	31	11	R0802_001_0	10	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R0802	001	0	1	31	11	R0802_001_0	10	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R0802	001	0	1	31	11	R0802_001_0	10	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R0802	001	0	1	31	11	R0802_001_0	10	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	10	1						
R0865	003	0	1	31	11	R0865_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R0865	003	0	1	31	11	R0865_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R0865	003	0	1	31	11	R0865_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R0865	003	0	1	31	11	R0865_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R0865	003	0	1	31	11	R0865_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R0923	002	0	1	31	11	R0923_002_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R0923	002	0	1	31	11	R0923_002_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R0923	002	0	1	31	11	R0923_002_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R0923	002	0	1	31	11	R0923_002_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R0923	002	0	1	31	11	R0923_002_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R1390	002	0	1	31	11	R1390_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R1390	002	0	1	31	11	R1390_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R1390	002	0	1	31	11	R1390_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R1390	002	0	1	31	11	R1390_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R1390	002	0	1	31	11	R1390_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R1532	002	0	1	31	11	R1532_002_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R1532	002	0	1	31	11	R1532_002_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R1532	002	0	1	31	11	R1532_002_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R1532	002	0	1	31	11	R1532_002_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R1532	002	0	1	31	11	R1532_002_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R2604	001	0	1	31	11	R2604_001_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R2604	001	0	1	31	11	R2604_001_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R2604	001	0	1	31	11	R2604_001_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R2604	001	0	1	31	11	R2604_001_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R2604	001	0	1	31	11	R2604_001_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R2604	003	0	1	31	11	R2604_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R2604	003	0	1	31	11	R2604_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R2604	003	0	1	31	11	R2604_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R2604	003	0	1	31	11	R2604_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R2604	003	0	1	31	11	R2604_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R3332	001	0	1	31	11	R3332_001_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
R3332	001	0	1	31	11	R3332_001_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
R3332	001	0	1	31	11	R3332_001_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
R3332	001	0	1	31	11	R3332_001_0	8	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
R3332	001	0	1	31	11	R3332_001_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
R3332	001	0	1	31	11	R3332_001_0	8	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
R3392	002	0	1	31	11	R3392_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R3392	002	0	1	31	11	R3392_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R3392	002	0	1	31	11	R3392_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R3392	002	0	1	31	11	R3392_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R3392	002	0	1	31	11	R3392_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R3444	009	0	1	31	11	R3444_009_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R3444	009	0	1	31	11	R3444_009_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R3444	009	0	1	31	11	R3444_009_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R3444	009	0	1	31	11	R3444_009_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R3444	009	0	1	31	11	R3444_009_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R3444	012	0	1	31	11	R3444_012_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R3444	012	0	1	31	11	R3444_012_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R3444	012	0	1	31	11	R3444_012_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R3444	012	0	1	31	11	R3444_012_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R3444	012	0	1	31	11	R3444_012_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R3444	023	0	1	31	11	R3444_023_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R3444	023	0	1	31	11	R3444_023_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R3444	023	0	1	31	11	R3444_023_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R3444	023	0	1	31	11	R3444_023_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R3444	023	0	1	31	11	R3444_023_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R3887	002	0	1	31	11	R3887_002_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R3887	002	0	1	31	11	R3887_002_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R3887	002	0	1	31	11	R3887_002_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R3887	002	0	1	31	11	R3887_002_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R3887	002	0	1	31	11	R3887_002_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R4182	003	0	1	31	11	R4182_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R4182	003	0	1	31	11	R4182_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R4182	003	0	1	31	11	R4182_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R4182	003	0	1	31	11	R4182_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R4182	003	0	1	31	11	R4182_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R4182	004	0	1	31	11	R4182_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R4182	004	0	1	31	11	R4182_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R4182	004	0	1	31	11	R4182_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R4182	004	0	1	31	11	R4182_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R4182	004	0	1	31	11	R4182_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R4487	001	0	1	31	11	R4487_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
R4487	001	0	1	31	11	R4487_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
R4487	001	0	1	31	11	R4487_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
R4487	001	0	1	31	11	R4487_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
R4487	001	0	1	31	11	R4487_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
R4487	001	0	1	31	11	R4487_001_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
R4845	002	0	1	31	11	R4845_002_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R4845	002	0	1	31	11	R4845_002_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R4845	002	0	1	31	11	R4845_002_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R4845	002	0	1	31	11	R4845_002_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R4845	002	0	1	31	11	R4845_002_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R5329	001	0	1	31	11	R5329_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R5329	001	0	1	31	11	R5329_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R5329	001	0	1	31	11	R5329_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R5329	001	0	1	31	11	R5329_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R5329	001	0	1	31	11	R5329_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R5342	001	0	1	31	11	R5342_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R5342	001	0	1	31	11	R5342_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R5342	001	0	1	31	11	R5342_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R5342	001	0	1	31	11	R5342_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R5342	001	0	1	31	11	R5342_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R5342	005	0	1	31	11	R5342_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R5342	005	0	1	31	11	R5342_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R5342	005	0	1	31	11	R5342_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R5342	005	0	1	31	11	R5342_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R5342	005	0	1	31	11	R5342_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R5342	006	0	1	31	11	R5342_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R5342	006	0	1	31	11	R5342_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R5342	006	0	1	31	11	R5342_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R5342	006	0	1	31	11	R5342_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R5342	006	0	1	31	11	R5342_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R5361	002	0	1	31	11	R5361_002_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R5361	002	0	1	31	11	R5361_002_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R5361	002	0	1	31	11	R5361_002_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R5361	002	0	1	31	11	R5361_002_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R5361	002	0	1	31	11	R5361_002_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R5495	002	0	1	31	11	R5495_002_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R5495	002	0	1	31	11	R5495_002_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R5495	002	0	1	31	11	R5495_002_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R5495	002	0	1	31	11	R5495_002_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R5495	002	0	1	31	11	R5495_002_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R5826	005	0	1	31	11	R5826_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
R5826	005	0	1	31	11	R5826_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R5826	005	0	1	31	11	R5826_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R5826	005	0	1	31	11	R5826_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R5826	005	0	1	31	11	R5826_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R5826	074	0	1	31	11	R5826_074_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	3						
R5826	074	0	1	31	11	R5826_074_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R5826	074	0	1	31	11	R5826_074_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R5826	074	0	1	31	11	R5826_074_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R5826	074	0	1	31	11	R5826_074_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R5941	014	0	1	31	11	R5941_014_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
R5941	014	0	1	31	11	R5941_014_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
R5941	014	0	1	31	11	R5941_014_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
R5941	014	0	1	31	11	R5941_014_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
R5941	014	0	1	31	11	R5941_014_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
R5941	014	0	1	31	11	R5941_014_0	5	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
R6694	003	0	1	31	11	R6694_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R6694	003	0	1	31	11	R6694_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
R6694	003	0	1	31	11	R6694_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R6694	003	0	1	31	11	R6694_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R6694	003	0	1	31	11	R6694_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R6694	005	0	1	31	11	R6694_005_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R6694	005	0	1	31	11	R6694_005_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
R6694	005	0	1	31	11	R6694_005_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R6694	005	0	1	31	11	R6694_005_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R6694	005	0	1	31	11	R6694_005_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R6694	006	0	1	31	11	R6694_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R6694	006	0	1	31	11	R6694_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
R6694	006	0	1	31	11	R6694_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R6694	006	0	1	31	11	R6694_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R6694	006	0	1	31	11	R6694_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R6801	009	0	1	31	11	R6801_009_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R6801	009	0	1	31	11	R6801_009_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R6801	009	0	1	31	11	R6801_009_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R6801	009	0	1	31	11	R6801_009_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R6801	009	0	1	31	11	R6801_009_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R6801	012	0	1	31	11	R6801_012_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R6801	012	0	1	31	11	R6801_012_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R6801	012	0	1	31	11	R6801_012_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R6801	012	0	1	31	11	R6801_012_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R6801	012	0	1	31	11	R6801_012_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R7220	002	0	1	31	11	R7220_002_0	8	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R7220	002	0	1	31	11	R7220_002_0	8	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R7220	002	0	1	31	11	R7220_002_0	8	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R7220	002	0	1	31	11	R7220_002_0	8	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R7220	002	0	1	31	11	R7220_002_0	8	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R7315	002	0	1	31	11	R7315_002_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
R7315	002	0	1	31	11	R7315_002_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
R7315	002	0	1	31	11	R7315_002_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R7315	002	0	1	31	11	R7315_002_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R7315	002	0	1	31	11	R7315_002_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
R7444	001	0	1	31	11	R7444_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
R7444	001	0	1	31	11	R7444_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
R7444	001	0	1	31	11	R7444_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
R7444	001	0	1	31	11	R7444_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
R7444	001	0	1	31	11	R7444_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S1030	001	0		29	10	S1030_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S1030	001	0		29	10	S1030_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S1030	001	0		29	10	S1030_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S1030	001	0		29	10	S1030_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S1030	001	0		29	10	S1030_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S1030	006	0		29	10	S1030_006_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S1030	006	0		29	10	S1030_006_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S1030	006	0		29	10	S1030_006_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S1030	006	0		29	10	S1030_006_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S1030	006	0		29	10	S1030_006_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S1030	010	0		29	10	S1030_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S1030	010	0		29	10	S1030_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S1030	010	0		29	10	S1030_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S1030	010	0		29	10	S1030_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S1030	010	0		29	10	S1030_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S1894	001	0		29	10	S1894_001_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S1894	001	0		29	10	S1894_001_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S1894	001	0		29	10	S1894_001_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S1894	001	0		29	10	S1894_001_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S1894	001	0		29	10	S1894_001_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S2468	003	0		29	10	S2468_003_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S2468	003	0		29	10	S2468_003_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S2468	003	0		29	10	S2468_003_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S2468	003	0		29	10	S2468_003_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S2468	003	0		29	10	S2468_003_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S2468	004	0		29	10	S2468_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S2468	004	0		29	10	S2468_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S2468	004	0		29	10	S2468_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S2468	004	0		29	10	S2468_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S2468	004	0		29	10	S2468_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S2668	005	0		29	10	S2668_005_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S2668	005	0		29	10	S2668_005_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S2668	005	0		29	10	S2668_005_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S2668	005	0		29	10	S2668_005_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S2668	005	0		29	10	S2668_005_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S2668	006	0		29	10	S2668_006_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S2668	006	0		29	10	S2668_006_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S2668	006	0		29	10	S2668_006_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S2668	006	0		29	10	S2668_006_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S2668	006	0		29	10	S2668_006_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S2874	001	0		29	10	S2874_001_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S2874	001	0		29	10	S2874_001_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S2874	001	0		29	10	S2874_001_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S2874	001	0		29	10	S2874_001_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S2874	001	0		29	10	S2874_001_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S2874	004	0		29	10	S2874_004_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S2874	004	0		29	10	S2874_004_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S2874	004	0		29	10	S2874_004_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S2874	004	0		29	10	S2874_004_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S2874	004	0		29	10	S2874_004_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S2893	001	0		29	10	S2893_001_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S2893	001	0		29	10	S2893_001_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S2893	001	0		29	10	S2893_001_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S2893	001	0		29	10	S2893_001_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S2893	001	0		29	10	S2893_001_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S2893	003	0		29	10	S2893_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S2893	003	0		29	10	S2893_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S2893	003	0		29	10	S2893_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S2893	003	0		29	10	S2893_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S2893	003	0		29	10	S2893_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3375	001	0		29	10	S3375_001_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3375	001	0		29	10	S3375_001_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3375	001	0		29	10	S3375_001_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S3375	001	0		29	10	S3375_001_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3375	001	0		29	10	S3375_001_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3375	002	0		29	10	S3375_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3375	002	0		29	10	S3375_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3375	002	0		29	10	S3375_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S3375	002	0		29	10	S3375_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3375	002	0		29	10	S3375_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3375	003	0		29	10	S3375_003_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3375	003	0		29	10	S3375_003_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3375	003	0		29	10	S3375_003_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S3375	003	0		29	10	S3375_003_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3375	003	0		29	10	S3375_003_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3535	005	0		29	10	S3535_005_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3535	005	0		29	10	S3535_005_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3535	005	0		29	10	S3535_005_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S3535	005	0		29	10	S3535_005_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3535	005	0		29	10	S3535_005_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3535	006	0		29	10	S3535_006_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3535	006	0		29	10	S3535_006_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3535	006	0		29	10	S3535_006_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S3535	006	0		29	10	S3535_006_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3535	006	0		29	10	S3535_006_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3535	007	0		29	10	S3535_007_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3535	007	0		29	10	S3535_007_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3535	007	0		29	10	S3535_007_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S3535	007	0		29	10	S3535_007_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3535	007	0		29	10	S3535_007_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3535	008	0		29	10	S3535_008_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3535	008	0		29	10	S3535_008_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3535	008	0		29	10	S3535_008_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S3535	008	0		29	10	S3535_008_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3535	008	0		29	10	S3535_008_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3535	009	0		29	10	S3535_009_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3535	009	0		29	10	S3535_009_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3535	009	0		29	10	S3535_009_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S3535	009	0		29	10	S3535_009_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3535	009	0		29	10	S3535_009_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3535	010	0		29	10	S3535_010_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3535	010	0		29	10	S3535_010_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3535	010	0		29	10	S3535_010_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S3535	010	0		29	10	S3535_010_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3535	010	0		29	10	S3535_010_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3535	011	0		29	10	S3535_011_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3535	011	0		29	10	S3535_011_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3535	011	0		29	10	S3535_011_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S3535	011	0		29	10	S3535_011_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3535	011	0		29	10	S3535_011_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S3535	012	0		29	10	S3535_012_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S3535	012	0		29	10	S3535_012_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S3535	012	0		29	10	S3535_012_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S3535	012	0		29	10	S3535_012_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S3535	012	0		29	10	S3535_012_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	012	0		29	10	S4802_012_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	012	0		29	10	S4802_012_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	012	0		29	10	S4802_012_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	012	0		29	10	S4802_012_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	012	0		29	10	S4802_012_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	013	0		29	10	S4802_013_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	013	0		29	10	S4802_013_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	013	0		29	10	S4802_013_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	013	0		29	10	S4802_013_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	013	0		29	10	S4802_013_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	014	0		29	10	S4802_014_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	014	0		29	10	S4802_014_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	014	0		29	10	S4802_014_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	014	0		29	10	S4802_014_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	014	0		29	10	S4802_014_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	020	0		29	10	S4802_020_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	020	0		29	10	S4802_020_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	020	0		29	10	S4802_020_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	020	0		29	10	S4802_020_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	020	0		29	10	S4802_020_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	021	0		29	10	S4802_021_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	021	0		29	10	S4802_021_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	021	0		29	10	S4802_021_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	021	0		29	10	S4802_021_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	021	0		29	10	S4802_021_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	069	0		29	10	S4802_069_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	069	0		29	10	S4802_069_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	069	0		29	10	S4802_069_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	069	0		29	10	S4802_069_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	069	0		29	10	S4802_069_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	070	0		29	10	S4802_070_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	070	0		29	10	S4802_070_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	070	0		29	10	S4802_070_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	070	0		29	10	S4802_070_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	070	0		29	10	S4802_070_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	071	0		29	10	S4802_071_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	071	0		29	10	S4802_071_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	071	0		29	10	S4802_071_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	071	0		29	10	S4802_071_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	071	0		29	10	S4802_071_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	072	0		29	10	S4802_072_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	072	0		29	10	S4802_072_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	072	0		29	10	S4802_072_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	072	0		29	10	S4802_072_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	072	0		29	10	S4802_072_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	073	0		29	10	S4802_073_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	073	0		29	10	S4802_073_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	073	0		29	10	S4802_073_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	073	0		29	10	S4802_073_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	073	0		29	10	S4802_073_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	074	0		29	10	S4802_074_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	074	0		29	10	S4802_074_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	074	0		29	10	S4802_074_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	074	0		29	10	S4802_074_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	074	0		29	10	S4802_074_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	075	0		29	10	S4802_075_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	075	0		29	10	S4802_075_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	075	0		29	10	S4802_075_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	075	0		29	10	S4802_075_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	075	0		29	10	S4802_075_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	076	0		29	10	S4802_076_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	076	0		29	10	S4802_076_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	076	0		29	10	S4802_076_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	076	0		29	10	S4802_076_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	076	0		29	10	S4802_076_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	077	0		29	10	S4802_077_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	077	0		29	10	S4802_077_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	077	0		29	10	S4802_077_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	077	0		29	10	S4802_077_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	077	0		29	10	S4802_077_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	078	0		29	10	S4802_078_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	078	0		29	10	S4802_078_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	078	0		29	10	S4802_078_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	078	0		29	10	S4802_078_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	078	0		29	10	S4802_078_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	079	0		29	10	S4802_079_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	079	0		29	10	S4802_079_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	079	0		29	10	S4802_079_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	079	0		29	10	S4802_079_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	079	0		29	10	S4802_079_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	080	0		29	10	S4802_080_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	080	0		29	10	S4802_080_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	080	0		29	10	S4802_080_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	080	0		29	10	S4802_080_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	080	0		29	10	S4802_080_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	081	0		29	10	S4802_081_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	081	0		29	10	S4802_081_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	081	0		29	10	S4802_081_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	081	0		29	10	S4802_081_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	081	0		29	10	S4802_081_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	082	0		29	10	S4802_082_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	082	0		29	10	S4802_082_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	082	0		29	10	S4802_082_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	082	0		29	10	S4802_082_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	082	0		29	10	S4802_082_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	083	0		29	10	S4802_083_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	083	0		29	10	S4802_083_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	083	0		29	10	S4802_083_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	083	0		29	10	S4802_083_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	083	0		29	10	S4802_083_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	084	0		29	10	S4802_084_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	084	0		29	10	S4802_084_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	084	0		29	10	S4802_084_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	084	0		29	10	S4802_084_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	084	0		29	10	S4802_084_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	085	0		29	10	S4802_085_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	085	0		29	10	S4802_085_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	085	0		29	10	S4802_085_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	085	0		29	10	S4802_085_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	085	0		29	10	S4802_085_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	086	0		29	10	S4802_086_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	086	0		29	10	S4802_086_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	086	0		29	10	S4802_086_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	086	0		29	10	S4802_086_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	086	0		29	10	S4802_086_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	087	0		29	10	S4802_087_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	087	0		29	10	S4802_087_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	087	0		29	10	S4802_087_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	087	0		29	10	S4802_087_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	087	0		29	10	S4802_087_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	088	0		29	10	S4802_088_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	088	0		29	10	S4802_088_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	088	0		29	10	S4802_088_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	088	0		29	10	S4802_088_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	088	0		29	10	S4802_088_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	089	0		29	10	S4802_089_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	089	0		29	10	S4802_089_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	089	0		29	10	S4802_089_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	089	0		29	10	S4802_089_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	089	0		29	10	S4802_089_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	090	0		29	10	S4802_090_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	090	0		29	10	S4802_090_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	090	0		29	10	S4802_090_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	090	0		29	10	S4802_090_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	090	0		29	10	S4802_090_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	091	0		29	10	S4802_091_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	091	0		29	10	S4802_091_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	091	0		29	10	S4802_091_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	091	0		29	10	S4802_091_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	091	0		29	10	S4802_091_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	092	0		29	10	S4802_092_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	092	0		29	10	S4802_092_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	092	0		29	10	S4802_092_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	092	0		29	10	S4802_092_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	092	0		29	10	S4802_092_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	093	0		29	10	S4802_093_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	093	0		29	10	S4802_093_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	093	0		29	10	S4802_093_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	093	0		29	10	S4802_093_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	093	0		29	10	S4802_093_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	094	0		29	10	S4802_094_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	094	0		29	10	S4802_094_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	094	0		29	10	S4802_094_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	094	0		29	10	S4802_094_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	094	0		29	10	S4802_094_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	095	0		29	10	S4802_095_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	095	0		29	10	S4802_095_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	095	0		29	10	S4802_095_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	095	0		29	10	S4802_095_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	095	0		29	10	S4802_095_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	096	0		29	10	S4802_096_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	096	0		29	10	S4802_096_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	096	0		29	10	S4802_096_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	096	0		29	10	S4802_096_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	096	0		29	10	S4802_096_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	097	0		29	10	S4802_097_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	097	0		29	10	S4802_097_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	097	0		29	10	S4802_097_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	097	0		29	10	S4802_097_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	097	0		29	10	S4802_097_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	132	0		29	10	S4802_132_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	132	0		29	10	S4802_132_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	132	0		29	10	S4802_132_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	132	0		29	10	S4802_132_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	132	0		29	10	S4802_132_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	133	0		29	10	S4802_133_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	133	0		29	10	S4802_133_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	133	0		29	10	S4802_133_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	133	0		29	10	S4802_133_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	133	0		29	10	S4802_133_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	134	0		29	10	S4802_134_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	134	0		29	10	S4802_134_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	134	0		29	10	S4802_134_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	134	0		29	10	S4802_134_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	134	0		29	10	S4802_134_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	135	0		29	10	S4802_135_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	135	0		29	10	S4802_135_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	135	0		29	10	S4802_135_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	135	0		29	10	S4802_135_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	135	0		29	10	S4802_135_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	136	0		29	10	S4802_136_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	136	0		29	10	S4802_136_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	136	0		29	10	S4802_136_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	136	0		29	10	S4802_136_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	136	0		29	10	S4802_136_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	137	0		29	10	S4802_137_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	137	0		29	10	S4802_137_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	137	0		29	10	S4802_137_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	137	0		29	10	S4802_137_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	137	0		29	10	S4802_137_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	138	0		29	10	S4802_138_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	138	0		29	10	S4802_138_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	138	0		29	10	S4802_138_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	138	0		29	10	S4802_138_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	138	0		29	10	S4802_138_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	139	0		29	10	S4802_139_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	139	0		29	10	S4802_139_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	139	0		29	10	S4802_139_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	139	0		29	10	S4802_139_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	139	0		29	10	S4802_139_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	140	0		29	10	S4802_140_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	140	0		29	10	S4802_140_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	140	0		29	10	S4802_140_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	140	0		29	10	S4802_140_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	140	0		29	10	S4802_140_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	141	0		29	10	S4802_141_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	141	0		29	10	S4802_141_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	141	0		29	10	S4802_141_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	141	0		29	10	S4802_141_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	141	0		29	10	S4802_141_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	142	0		29	10	S4802_142_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	142	0		29	10	S4802_142_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	142	0		29	10	S4802_142_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	142	0		29	10	S4802_142_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	142	0		29	10	S4802_142_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	143	0		29	10	S4802_143_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	143	0		29	10	S4802_143_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	143	0		29	10	S4802_143_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	143	0		29	10	S4802_143_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	143	0		29	10	S4802_143_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	144	0		29	10	S4802_144_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	144	0		29	10	S4802_144_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	144	0		29	10	S4802_144_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	144	0		29	10	S4802_144_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	144	0		29	10	S4802_144_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	145	0		29	10	S4802_145_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	145	0		29	10	S4802_145_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	145	0		29	10	S4802_145_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	145	0		29	10	S4802_145_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	145	0		29	10	S4802_145_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	146	0		29	10	S4802_146_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	146	0		29	10	S4802_146_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	146	0		29	10	S4802_146_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	146	0		29	10	S4802_146_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	146	0		29	10	S4802_146_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	147	0		29	10	S4802_147_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	147	0		29	10	S4802_147_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	147	0		29	10	S4802_147_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	147	0		29	10	S4802_147_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	147	0		29	10	S4802_147_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	148	0		29	10	S4802_148_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	148	0		29	10	S4802_148_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	148	0		29	10	S4802_148_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	148	0		29	10	S4802_148_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	148	0		29	10	S4802_148_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	149	0		29	10	S4802_149_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	149	0		29	10	S4802_149_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	149	0		29	10	S4802_149_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	149	0		29	10	S4802_149_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	149	0		29	10	S4802_149_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	150	0		29	10	S4802_150_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	150	0		29	10	S4802_150_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	150	0		29	10	S4802_150_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	150	0		29	10	S4802_150_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	150	0		29	10	S4802_150_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	151	0		29	10	S4802_151_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	151	0		29	10	S4802_151_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	151	0		29	10	S4802_151_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	151	0		29	10	S4802_151_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	151	0		29	10	S4802_151_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	152	0		29	10	S4802_152_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	152	0		29	10	S4802_152_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	152	0		29	10	S4802_152_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	152	0		29	10	S4802_152_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	152	0		29	10	S4802_152_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	153	0		29	10	S4802_153_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	153	0		29	10	S4802_153_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	153	0		29	10	S4802_153_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	153	0		29	10	S4802_153_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	153	0		29	10	S4802_153_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	154	0		29	10	S4802_154_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	154	0		29	10	S4802_154_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	154	0		29	10	S4802_154_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	154	0		29	10	S4802_154_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	154	0		29	10	S4802_154_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	155	0		29	10	S4802_155_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	155	0		29	10	S4802_155_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	155	0		29	10	S4802_155_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	155	0		29	10	S4802_155_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	155	0		29	10	S4802_155_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	156	0		29	10	S4802_156_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	156	0		29	10	S4802_156_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	156	0		29	10	S4802_156_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	156	0		29	10	S4802_156_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	156	0		29	10	S4802_156_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	157	0		29	10	S4802_157_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	157	0		29	10	S4802_157_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	157	0		29	10	S4802_157_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	157	0		29	10	S4802_157_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	157	0		29	10	S4802_157_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	158	0		29	10	S4802_158_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	158	0		29	10	S4802_158_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	158	0		29	10	S4802_158_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	158	0		29	10	S4802_158_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	158	0		29	10	S4802_158_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	159	0		29	10	S4802_159_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	159	0		29	10	S4802_159_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	159	0		29	10	S4802_159_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	159	0		29	10	S4802_159_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	159	0		29	10	S4802_159_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	160	0		29	10	S4802_160_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	160	0		29	10	S4802_160_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	160	0		29	10	S4802_160_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	160	0		29	10	S4802_160_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	160	0		29	10	S4802_160_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	161	0		29	10	S4802_161_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	161	0		29	10	S4802_161_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	161	0		29	10	S4802_161_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	161	0		29	10	S4802_161_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	161	0		29	10	S4802_161_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	162	0		29	10	S4802_162_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	162	0		29	10	S4802_162_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	162	0		29	10	S4802_162_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	162	0		29	10	S4802_162_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	162	0		29	10	S4802_162_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	163	0		29	10	S4802_163_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	163	0		29	10	S4802_163_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	163	0		29	10	S4802_163_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	163	0		29	10	S4802_163_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	163	0		29	10	S4802_163_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	164	0		29	10	S4802_164_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	164	0		29	10	S4802_164_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	164	0		29	10	S4802_164_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	164	0		29	10	S4802_164_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	164	0		29	10	S4802_164_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	165	0		29	10	S4802_165_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	165	0		29	10	S4802_165_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	165	0		29	10	S4802_165_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	165	0		29	10	S4802_165_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	165	0		29	10	S4802_165_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	170	0		29	10	S4802_170_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	170	0		29	10	S4802_170_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	170	0		29	10	S4802_170_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	170	0		29	10	S4802_170_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	170	0		29	10	S4802_170_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	171	0		29	10	S4802_171_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	171	0		29	10	S4802_171_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	171	0		29	10	S4802_171_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	171	0		29	10	S4802_171_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	171	0		29	10	S4802_171_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	172	0		29	10	S4802_172_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	172	0		29	10	S4802_172_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	172	0		29	10	S4802_172_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	172	0		29	10	S4802_172_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	172	0		29	10	S4802_172_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	173	0		29	10	S4802_173_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	173	0		29	10	S4802_173_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	173	0		29	10	S4802_173_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	173	0		29	10	S4802_173_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	173	0		29	10	S4802_173_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	174	0		29	10	S4802_174_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	174	0		29	10	S4802_174_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	174	0		29	10	S4802_174_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	174	0		29	10	S4802_174_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	174	0		29	10	S4802_174_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	175	0		29	10	S4802_175_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	175	0		29	10	S4802_175_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	175	0		29	10	S4802_175_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	175	0		29	10	S4802_175_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	175	0		29	10	S4802_175_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	176	0		29	10	S4802_176_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	176	0		29	10	S4802_176_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	176	0		29	10	S4802_176_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	176	0		29	10	S4802_176_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	176	0		29	10	S4802_176_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	177	0		29	10	S4802_177_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	177	0		29	10	S4802_177_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	177	0		29	10	S4802_177_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	177	0		29	10	S4802_177_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	177	0		29	10	S4802_177_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	178	0		29	10	S4802_178_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	178	0		29	10	S4802_178_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	178	0		29	10	S4802_178_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	178	0		29	10	S4802_178_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	178	0		29	10	S4802_178_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	179	0		29	10	S4802_179_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	179	0		29	10	S4802_179_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	179	0		29	10	S4802_179_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	179	0		29	10	S4802_179_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	179	0		29	10	S4802_179_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	180	0		29	10	S4802_180_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	180	0		29	10	S4802_180_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	180	0		29	10	S4802_180_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	180	0		29	10	S4802_180_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	180	0		29	10	S4802_180_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	181	0		29	10	S4802_181_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	181	0		29	10	S4802_181_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	181	0		29	10	S4802_181_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	181	0		29	10	S4802_181_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	181	0		29	10	S4802_181_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	182	0		29	10	S4802_182_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	182	0		29	10	S4802_182_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	182	0		29	10	S4802_182_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	182	0		29	10	S4802_182_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	182	0		29	10	S4802_182_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	183	0		29	10	S4802_183_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	183	0		29	10	S4802_183_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	183	0		29	10	S4802_183_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	183	0		29	10	S4802_183_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	183	0		29	10	S4802_183_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	184	0		29	10	S4802_184_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	184	0		29	10	S4802_184_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	184	0		29	10	S4802_184_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	184	0		29	10	S4802_184_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	184	0		29	10	S4802_184_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	185	0		29	10	S4802_185_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	185	0		29	10	S4802_185_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	185	0		29	10	S4802_185_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	185	0		29	10	S4802_185_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	185	0		29	10	S4802_185_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	186	0		29	10	S4802_186_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	186	0		29	10	S4802_186_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	186	0		29	10	S4802_186_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	186	0		29	10	S4802_186_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	186	0		29	10	S4802_186_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	187	0		29	10	S4802_187_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	187	0		29	10	S4802_187_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	187	0		29	10	S4802_187_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	187	0		29	10	S4802_187_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	187	0		29	10	S4802_187_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	188	0		29	10	S4802_188_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	188	0		29	10	S4802_188_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	188	0		29	10	S4802_188_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	188	0		29	10	S4802_188_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	188	0		29	10	S4802_188_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	189	0		29	10	S4802_189_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	189	0		29	10	S4802_189_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	189	0		29	10	S4802_189_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	189	0		29	10	S4802_189_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	189	0		29	10	S4802_189_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	190	0		29	10	S4802_190_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	190	0		29	10	S4802_190_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	190	0		29	10	S4802_190_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	190	0		29	10	S4802_190_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	190	0		29	10	S4802_190_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	191	0		29	10	S4802_191_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	191	0		29	10	S4802_191_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	191	0		29	10	S4802_191_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	191	0		29	10	S4802_191_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	191	0		29	10	S4802_191_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	192	0		29	10	S4802_192_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	192	0		29	10	S4802_192_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	192	0		29	10	S4802_192_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	192	0		29	10	S4802_192_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	192	0		29	10	S4802_192_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	193	0		29	10	S4802_193_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	193	0		29	10	S4802_193_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	193	0		29	10	S4802_193_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	193	0		29	10	S4802_193_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	193	0		29	10	S4802_193_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	194	0		29	10	S4802_194_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	194	0		29	10	S4802_194_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	194	0		29	10	S4802_194_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	194	0		29	10	S4802_194_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	194	0		29	10	S4802_194_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	195	0		29	10	S4802_195_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	195	0		29	10	S4802_195_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	195	0		29	10	S4802_195_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	195	0		29	10	S4802_195_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	195	0		29	10	S4802_195_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	196	0		29	10	S4802_196_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	196	0		29	10	S4802_196_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	196	0		29	10	S4802_196_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	196	0		29	10	S4802_196_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	196	0		29	10	S4802_196_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	197	0		29	10	S4802_197_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	197	0		29	10	S4802_197_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	197	0		29	10	S4802_197_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	197	0		29	10	S4802_197_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	197	0		29	10	S4802_197_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	198	0		29	10	S4802_198_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	198	0		29	10	S4802_198_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	198	0		29	10	S4802_198_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	198	0		29	10	S4802_198_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	198	0		29	10	S4802_198_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	199	0		29	10	S4802_199_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	199	0		29	10	S4802_199_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	199	0		29	10	S4802_199_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	199	0		29	10	S4802_199_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	199	0		29	10	S4802_199_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	200	0		29	10	S4802_200_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	200	0		29	10	S4802_200_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	200	0		29	10	S4802_200_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	200	0		29	10	S4802_200_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	200	0		29	10	S4802_200_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	201	0		29	10	S4802_201_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	201	0		29	10	S4802_201_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	201	0		29	10	S4802_201_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	201	0		29	10	S4802_201_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	201	0		29	10	S4802_201_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	202	0		29	10	S4802_202_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	202	0		29	10	S4802_202_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	202	0		29	10	S4802_202_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	202	0		29	10	S4802_202_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	202	0		29	10	S4802_202_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S4802	203	0		29	10	S4802_203_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S4802	203	0		29	10	S4802_203_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S4802	203	0		29	10	S4802_203_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S4802	203	0		29	10	S4802_203_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S4802	203	0		29	10	S4802_203_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5540	002	0		29	10	S5540_002_0	6	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5540	002	0		29	10	S5540_002_0	6	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5540	002	0		29	10	S5540_002_0	6	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5540	002	0		29	10	S5540_002_0	6	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5540	002	0		29	10	S5540_002_0	6	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5540	004	0		29	10	S5540_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5540	004	0		29	10	S5540_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5540	004	0		29	10	S5540_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5540	004	0		29	10	S5540_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5540	004	0		29	10	S5540_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5552	004	0		29	10	S5552_004_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5552	004	0		29	10	S5552_004_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5552	004	0		29	10	S5552_004_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5552	004	0		29	10	S5552_004_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5552	004	0		29	10	S5552_004_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5552	005	0		29	10	S5552_005_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5552	005	0		29	10	S5552_005_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5552	005	0		29	10	S5552_005_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5552	005	0		29	10	S5552_005_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5552	005	0		29	10	S5552_005_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5552	006	0		29	10	S5552_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5552	006	0		29	10	S5552_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5552	006	0		29	10	S5552_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5552	006	0		29	10	S5552_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5552	006	0		29	10	S5552_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5584	002	0		29	10	S5584_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5584	002	0		29	10	S5584_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5584	002	0		29	10	S5584_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5584	002	0		29	10	S5584_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5584	002	0		29	10	S5584_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5593	002	0		29	10	S5593_002_0	5	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5593	002	0		29	10	S5593_002_0	5	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5593	002	0		29	10	S5593_002_0	5	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5593	002	0		29	10	S5593_002_0	5	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5593	002	0		29	10	S5593_002_0	5	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5593	003	0		29	10	S5593_003_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5593	003	0		29	10	S5593_003_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5593	003	0		29	10	S5593_003_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5593	003	0		29	10	S5593_003_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5593	003	0		29	10	S5593_003_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	001	0		29	10	S5596_001_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	001	0		29	10	S5596_001_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	001	0		29	10	S5596_001_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	001	0		29	10	S5596_001_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	001	0		29	10	S5596_001_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	005	0		29	10	S5596_005_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	005	0		29	10	S5596_005_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	005	0		29	10	S5596_005_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	005	0		29	10	S5596_005_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	005	0		29	10	S5596_005_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	006	0		29	10	S5596_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	006	0		29	10	S5596_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	006	0		29	10	S5596_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	006	0		29	10	S5596_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	006	0		29	10	S5596_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	009	0		29	10	S5596_009_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	009	0		29	10	S5596_009_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	009	0		29	10	S5596_009_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	009	0		29	10	S5596_009_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	009	0		29	10	S5596_009_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	010	0		29	10	S5596_010_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	010	0		29	10	S5596_010_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	010	0		29	10	S5596_010_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	010	0		29	10	S5596_010_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	010	0		29	10	S5596_010_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	013	0		29	10	S5596_013_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	013	0		29	10	S5596_013_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	013	0		29	10	S5596_013_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	013	0		29	10	S5596_013_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	013	0		29	10	S5596_013_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	014	0		29	10	S5596_014_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	014	0		29	10	S5596_014_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	014	0		29	10	S5596_014_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	014	0		29	10	S5596_014_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	014	0		29	10	S5596_014_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	017	0		29	10	S5596_017_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	017	0		29	10	S5596_017_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	017	0		29	10	S5596_017_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	017	0		29	10	S5596_017_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	017	0		29	10	S5596_017_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	018	0		29	10	S5596_018_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	018	0		29	10	S5596_018_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	018	0		29	10	S5596_018_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	018	0		29	10	S5596_018_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	018	0		29	10	S5596_018_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	033	0		29	10	S5596_033_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	033	0		29	10	S5596_033_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	033	0		29	10	S5596_033_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	033	0		29	10	S5596_033_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	033	0		29	10	S5596_033_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	034	0		29	10	S5596_034_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	034	0		29	10	S5596_034_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	034	0		29	10	S5596_034_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	034	0		29	10	S5596_034_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	034	0		29	10	S5596_034_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	043	0		29	10	S5596_043_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	043	0		29	10	S5596_043_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	043	0		29	10	S5596_043_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	043	0		29	10	S5596_043_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	043	0		29	10	S5596_043_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	044	0		29	10	S5596_044_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	044	0		29	10	S5596_044_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	044	0		29	10	S5596_044_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	044	0		29	10	S5596_044_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	044	0		29	10	S5596_044_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	046	0		29	10	S5596_046_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	046	0		29	10	S5596_046_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	046	0		29	10	S5596_046_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	046	0		29	10	S5596_046_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	046	0		29	10	S5596_046_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	056	0		29	10	S5596_056_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	056	0		29	10	S5596_056_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	056	0		29	10	S5596_056_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	056	0		29	10	S5596_056_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	056	0		29	10	S5596_056_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	057	0		29	10	S5596_057_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	057	0		29	10	S5596_057_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	057	0		29	10	S5596_057_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	057	0		29	10	S5596_057_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	057	0		29	10	S5596_057_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	059	0		29	10	S5596_059_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	059	0		29	10	S5596_059_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	059	0		29	10	S5596_059_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	059	0		29	10	S5596_059_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	059	0		29	10	S5596_059_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	060	0		29	10	S5596_060_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	060	0		29	10	S5596_060_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	060	0		29	10	S5596_060_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	060	0		29	10	S5596_060_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	060	0		29	10	S5596_060_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	062	0		29	10	S5596_062_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	062	0		29	10	S5596_062_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	062	0		29	10	S5596_062_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	062	0		29	10	S5596_062_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	062	0		29	10	S5596_062_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	063	0		29	10	S5596_063_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	063	0		29	10	S5596_063_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	063	0		29	10	S5596_063_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	063	0		29	10	S5596_063_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	063	0		29	10	S5596_063_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	066	0		29	10	S5596_066_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	066	0		29	10	S5596_066_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	066	0		29	10	S5596_066_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	066	0		29	10	S5596_066_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	066	0		29	10	S5596_066_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	068	0		29	10	S5596_068_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	068	0		29	10	S5596_068_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	068	0		29	10	S5596_068_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	068	0		29	10	S5596_068_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	068	0		29	10	S5596_068_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	070	0		29	10	S5596_070_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	070	0		29	10	S5596_070_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	070	0		29	10	S5596_070_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	070	0		29	10	S5596_070_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	070	0		29	10	S5596_070_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	072	0		29	10	S5596_072_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	072	0		29	10	S5596_072_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	072	0		29	10	S5596_072_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	072	0		29	10	S5596_072_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	072	0		29	10	S5596_072_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	074	0		29	10	S5596_074_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	074	0		29	10	S5596_074_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	074	0		29	10	S5596_074_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	074	0		29	10	S5596_074_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	074	0		29	10	S5596_074_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	076	0		29	10	S5596_076_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	076	0		29	10	S5596_076_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	076	0		29	10	S5596_076_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	076	0		29	10	S5596_076_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	076	0		29	10	S5596_076_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	078	0		29	10	S5596_078_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	078	0		29	10	S5596_078_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	078	0		29	10	S5596_078_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	078	0		29	10	S5596_078_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	078	0		29	10	S5596_078_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	080	0		29	10	S5596_080_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	080	0		29	10	S5596_080_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	080	0		29	10	S5596_080_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	080	0		29	10	S5596_080_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	080	0		29	10	S5596_080_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	082	0		29	10	S5596_082_0	7	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	082	0		29	10	S5596_082_0	7	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	082	0		29	10	S5596_082_0	7	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	082	0		29	10	S5596_082_0	7	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	082	0		29	10	S5596_082_0	7	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5596	084	0		29	10	S5596_084_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5596	084	0		29	10	S5596_084_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5596	084	0		29	10	S5596_084_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5596	084	0		29	10	S5596_084_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5596	084	0		29	10	S5596_084_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	002	0		29	10	S5601_002_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	002	0		29	10	S5601_002_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	002	0		29	10	S5601_002_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	002	0		29	10	S5601_002_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	002	0		29	10	S5601_002_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	003	0		29	10	S5601_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	003	0		29	10	S5601_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	003	0		29	10	S5601_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	003	0		29	10	S5601_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	003	0		29	10	S5601_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	004	0		29	10	S5601_004_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	004	0		29	10	S5601_004_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	004	0		29	10	S5601_004_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	004	0		29	10	S5601_004_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	004	0		29	10	S5601_004_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	005	0		29	10	S5601_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	005	0		29	10	S5601_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	005	0		29	10	S5601_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	005	0		29	10	S5601_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	005	0		29	10	S5601_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	006	0		29	10	S5601_006_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	006	0		29	10	S5601_006_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	006	0		29	10	S5601_006_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	006	0		29	10	S5601_006_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	006	0		29	10	S5601_006_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	007	0		29	10	S5601_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	007	0		29	10	S5601_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	007	0		29	10	S5601_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	007	0		29	10	S5601_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	007	0		29	10	S5601_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	008	0		29	10	S5601_008_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	008	0		29	10	S5601_008_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	008	0		29	10	S5601_008_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	008	0		29	10	S5601_008_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	008	0		29	10	S5601_008_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	009	0		29	10	S5601_009_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	009	0		29	10	S5601_009_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	009	0		29	10	S5601_009_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	009	0		29	10	S5601_009_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	009	0		29	10	S5601_009_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	010	0		29	10	S5601_010_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	010	0		29	10	S5601_010_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	010	0		29	10	S5601_010_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	010	0		29	10	S5601_010_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	010	0		29	10	S5601_010_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	011	0		29	10	S5601_011_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	011	0		29	10	S5601_011_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	011	0		29	10	S5601_011_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	011	0		29	10	S5601_011_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	011	0		29	10	S5601_011_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	012	0		29	10	S5601_012_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	012	0		29	10	S5601_012_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	012	0		29	10	S5601_012_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	012	0		29	10	S5601_012_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	012	0		29	10	S5601_012_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	013	0		29	10	S5601_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	013	0		29	10	S5601_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	013	0		29	10	S5601_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	013	0		29	10	S5601_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	013	0		29	10	S5601_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	014	0		29	10	S5601_014_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	014	0		29	10	S5601_014_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	014	0		29	10	S5601_014_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	014	0		29	10	S5601_014_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	014	0		29	10	S5601_014_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	015	0		29	10	S5601_015_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	015	0		29	10	S5601_015_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	015	0		29	10	S5601_015_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	015	0		29	10	S5601_015_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	015	0		29	10	S5601_015_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	016	0		29	10	S5601_016_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	016	0		29	10	S5601_016_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	016	0		29	10	S5601_016_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	016	0		29	10	S5601_016_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	016	0		29	10	S5601_016_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	017	0		29	10	S5601_017_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	017	0		29	10	S5601_017_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	017	0		29	10	S5601_017_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	017	0		29	10	S5601_017_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	017	0		29	10	S5601_017_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	018	0		29	10	S5601_018_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	018	0		29	10	S5601_018_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	018	0		29	10	S5601_018_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	018	0		29	10	S5601_018_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	018	0		29	10	S5601_018_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	019	0		29	10	S5601_019_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	019	0		29	10	S5601_019_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	019	0		29	10	S5601_019_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	019	0		29	10	S5601_019_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	019	0		29	10	S5601_019_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	020	0		29	10	S5601_020_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	020	0		29	10	S5601_020_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	020	0		29	10	S5601_020_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	020	0		29	10	S5601_020_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	020	0		29	10	S5601_020_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	021	0		29	10	S5601_021_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	021	0		29	10	S5601_021_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	021	0		29	10	S5601_021_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	021	0		29	10	S5601_021_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	021	0		29	10	S5601_021_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	022	0		29	10	S5601_022_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	022	0		29	10	S5601_022_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	022	0		29	10	S5601_022_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	022	0		29	10	S5601_022_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	022	0		29	10	S5601_022_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	023	0		29	10	S5601_023_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	023	0		29	10	S5601_023_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	023	0		29	10	S5601_023_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	023	0		29	10	S5601_023_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	023	0		29	10	S5601_023_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	024	0		29	10	S5601_024_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	024	0		29	10	S5601_024_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	024	0		29	10	S5601_024_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	024	0		29	10	S5601_024_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	024	0		29	10	S5601_024_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	025	0		29	10	S5601_025_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	025	0		29	10	S5601_025_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	025	0		29	10	S5601_025_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	025	0		29	10	S5601_025_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	025	0		29	10	S5601_025_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	026	0		29	10	S5601_026_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	026	0		29	10	S5601_026_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	026	0		29	10	S5601_026_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	026	0		29	10	S5601_026_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	026	0		29	10	S5601_026_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	027	0		29	10	S5601_027_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	027	0		29	10	S5601_027_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	027	0		29	10	S5601_027_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	027	0		29	10	S5601_027_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	027	0		29	10	S5601_027_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	028	0		29	10	S5601_028_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	028	0		29	10	S5601_028_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	028	0		29	10	S5601_028_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	028	0		29	10	S5601_028_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	028	0		29	10	S5601_028_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	029	0		29	10	S5601_029_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	029	0		29	10	S5601_029_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	029	0		29	10	S5601_029_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	029	0		29	10	S5601_029_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	029	0		29	10	S5601_029_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	030	0		29	10	S5601_030_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	030	0		29	10	S5601_030_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	030	0		29	10	S5601_030_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	030	0		29	10	S5601_030_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	030	0		29	10	S5601_030_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	031	0		29	10	S5601_031_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	031	0		29	10	S5601_031_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	031	0		29	10	S5601_031_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	031	0		29	10	S5601_031_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	031	0		29	10	S5601_031_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	032	0		29	10	S5601_032_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	032	0		29	10	S5601_032_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	032	0		29	10	S5601_032_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	032	0		29	10	S5601_032_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	032	0		29	10	S5601_032_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	033	0		29	10	S5601_033_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	033	0		29	10	S5601_033_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	033	0		29	10	S5601_033_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	033	0		29	10	S5601_033_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	033	0		29	10	S5601_033_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	034	0		29	10	S5601_034_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	034	0		29	10	S5601_034_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	034	0		29	10	S5601_034_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	034	0		29	10	S5601_034_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	034	0		29	10	S5601_034_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	035	0		29	10	S5601_035_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	035	0		29	10	S5601_035_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	035	0		29	10	S5601_035_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	035	0		29	10	S5601_035_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	035	0		29	10	S5601_035_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	036	0		29	10	S5601_036_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	036	0		29	10	S5601_036_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	036	0		29	10	S5601_036_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	036	0		29	10	S5601_036_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	036	0		29	10	S5601_036_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	037	0		29	10	S5601_037_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	037	0		29	10	S5601_037_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	037	0		29	10	S5601_037_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	037	0		29	10	S5601_037_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	037	0		29	10	S5601_037_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	038	0		29	10	S5601_038_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	038	0		29	10	S5601_038_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	038	0		29	10	S5601_038_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	038	0		29	10	S5601_038_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	038	0		29	10	S5601_038_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	040	0		29	10	S5601_040_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	040	0		29	10	S5601_040_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	040	0		29	10	S5601_040_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	040	0		29	10	S5601_040_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	040	0		29	10	S5601_040_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	041	0		29	10	S5601_041_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	041	0		29	10	S5601_041_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	041	0		29	10	S5601_041_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	041	0		29	10	S5601_041_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	041	0		29	10	S5601_041_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	042	0		29	10	S5601_042_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	042	0		29	10	S5601_042_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	042	0		29	10	S5601_042_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	042	0		29	10	S5601_042_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	042	0		29	10	S5601_042_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	044	0		29	10	S5601_044_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	044	0		29	10	S5601_044_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	044	0		29	10	S5601_044_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	044	0		29	10	S5601_044_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	044	0		29	10	S5601_044_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	045	0		29	10	S5601_045_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	045	0		29	10	S5601_045_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	045	0		29	10	S5601_045_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	045	0		29	10	S5601_045_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	045	0		29	10	S5601_045_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	046	0		29	10	S5601_046_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	046	0		29	10	S5601_046_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	046	0		29	10	S5601_046_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	046	0		29	10	S5601_046_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	046	0		29	10	S5601_046_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	048	0		29	10	S5601_048_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	048	0		29	10	S5601_048_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	048	0		29	10	S5601_048_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	048	0		29	10	S5601_048_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	048	0		29	10	S5601_048_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	049	0		29	10	S5601_049_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	049	0		29	10	S5601_049_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	049	0		29	10	S5601_049_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	049	0		29	10	S5601_049_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	049	0		29	10	S5601_049_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	050	0		29	10	S5601_050_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	050	0		29	10	S5601_050_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	050	0		29	10	S5601_050_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	050	0		29	10	S5601_050_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	050	0		29	10	S5601_050_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	051	0		29	10	S5601_051_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	051	0		29	10	S5601_051_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	051	0		29	10	S5601_051_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	051	0		29	10	S5601_051_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	051	0		29	10	S5601_051_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	052	0		29	10	S5601_052_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	052	0		29	10	S5601_052_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	052	0		29	10	S5601_052_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	052	0		29	10	S5601_052_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	052	0		29	10	S5601_052_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	053	0		29	10	S5601_053_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	053	0		29	10	S5601_053_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	053	0		29	10	S5601_053_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	053	0		29	10	S5601_053_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	053	0		29	10	S5601_053_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	054	0		29	10	S5601_054_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	054	0		29	10	S5601_054_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	054	0		29	10	S5601_054_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	054	0		29	10	S5601_054_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	054	0		29	10	S5601_054_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	055	0		29	10	S5601_055_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	055	0		29	10	S5601_055_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	055	0		29	10	S5601_055_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	055	0		29	10	S5601_055_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	055	0		29	10	S5601_055_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	056	0		29	10	S5601_056_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	056	0		29	10	S5601_056_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	056	0		29	10	S5601_056_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	056	0		29	10	S5601_056_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	056	0		29	10	S5601_056_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	057	0		29	10	S5601_057_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	057	0		29	10	S5601_057_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	057	0		29	10	S5601_057_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	057	0		29	10	S5601_057_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	057	0		29	10	S5601_057_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	058	0		29	10	S5601_058_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	058	0		29	10	S5601_058_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	058	0		29	10	S5601_058_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	058	0		29	10	S5601_058_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	058	0		29	10	S5601_058_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	059	0		29	10	S5601_059_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	059	0		29	10	S5601_059_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	059	0		29	10	S5601_059_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	059	0		29	10	S5601_059_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	059	0		29	10	S5601_059_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	060	0		29	10	S5601_060_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	060	0		29	10	S5601_060_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	060	0		29	10	S5601_060_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	060	0		29	10	S5601_060_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	060	0		29	10	S5601_060_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	061	0		29	10	S5601_061_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	061	0		29	10	S5601_061_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	061	0		29	10	S5601_061_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	061	0		29	10	S5601_061_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	061	0		29	10	S5601_061_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	062	0		29	10	S5601_062_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	062	0		29	10	S5601_062_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	062	0		29	10	S5601_062_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	062	0		29	10	S5601_062_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	062	0		29	10	S5601_062_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	063	0		29	10	S5601_063_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	063	0		29	10	S5601_063_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	063	0		29	10	S5601_063_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	063	0		29	10	S5601_063_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	063	0		29	10	S5601_063_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	064	0		29	10	S5601_064_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	064	0		29	10	S5601_064_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	064	0		29	10	S5601_064_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	064	0		29	10	S5601_064_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	064	0		29	10	S5601_064_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	065	0		29	10	S5601_065_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	065	0		29	10	S5601_065_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	065	0		29	10	S5601_065_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	065	0		29	10	S5601_065_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	065	0		29	10	S5601_065_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	066	0		29	10	S5601_066_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	066	0		29	10	S5601_066_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	066	0		29	10	S5601_066_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	066	0		29	10	S5601_066_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	066	0		29	10	S5601_066_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	067	0		29	10	S5601_067_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	067	0		29	10	S5601_067_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	067	0		29	10	S5601_067_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	067	0		29	10	S5601_067_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	067	0		29	10	S5601_067_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	068	0		29	10	S5601_068_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	068	0		29	10	S5601_068_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5601	068	0		29	10	S5601_068_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	068	0		29	10	S5601_068_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	068	0		29	10	S5601_068_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	107	0		29	10	S5601_107_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	107	0		29	10	S5601_107_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	107	0		29	10	S5601_107_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	107	0		29	10	S5601_107_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	107	0		29	10	S5601_107_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	108	0		29	10	S5601_108_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	108	0		29	10	S5601_108_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	108	0		29	10	S5601_108_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	108	0		29	10	S5601_108_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	108	0		29	10	S5601_108_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	109	0		29	10	S5601_109_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	3						
S5601	109	0		29	10	S5601_109_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5601	109	0		29	10	S5601_109_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	109	0		29	10	S5601_109_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	109	0		29	10	S5601_109_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	176	0		29	10	S5601_176_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	176	0		29	10	S5601_176_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	176	0		29	10	S5601_176_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	176	0		29	10	S5601_176_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	176	0		29	10	S5601_176_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	177	0		29	10	S5601_177_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	177	0		29	10	S5601_177_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	177	0		29	10	S5601_177_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	177	0		29	10	S5601_177_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	177	0		29	10	S5601_177_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	178	0		29	10	S5601_178_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	178	0		29	10	S5601_178_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	178	0		29	10	S5601_178_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	178	0		29	10	S5601_178_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	178	0		29	10	S5601_178_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	179	0		29	10	S5601_179_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	179	0		29	10	S5601_179_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	179	0		29	10	S5601_179_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	179	0		29	10	S5601_179_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	179	0		29	10	S5601_179_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	180	0		29	10	S5601_180_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	180	0		29	10	S5601_180_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	180	0		29	10	S5601_180_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	180	0		29	10	S5601_180_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	180	0		29	10	S5601_180_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	181	0		29	10	S5601_181_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	181	0		29	10	S5601_181_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	181	0		29	10	S5601_181_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	181	0		29	10	S5601_181_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	181	0		29	10	S5601_181_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	182	0		29	10	S5601_182_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	182	0		29	10	S5601_182_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	182	0		29	10	S5601_182_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	182	0		29	10	S5601_182_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	182	0		29	10	S5601_182_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	183	0		29	10	S5601_183_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	183	0		29	10	S5601_183_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	183	0		29	10	S5601_183_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	183	0		29	10	S5601_183_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	183	0		29	10	S5601_183_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	184	0		29	10	S5601_184_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	184	0		29	10	S5601_184_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	184	0		29	10	S5601_184_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	184	0		29	10	S5601_184_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	184	0		29	10	S5601_184_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	185	0		29	10	S5601_185_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	185	0		29	10	S5601_185_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	185	0		29	10	S5601_185_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	185	0		29	10	S5601_185_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	185	0		29	10	S5601_185_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	186	0		29	10	S5601_186_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	186	0		29	10	S5601_186_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	186	0		29	10	S5601_186_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	186	0		29	10	S5601_186_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	186	0		29	10	S5601_186_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	187	0		29	10	S5601_187_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	187	0		29	10	S5601_187_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	187	0		29	10	S5601_187_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	187	0		29	10	S5601_187_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	187	0		29	10	S5601_187_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	188	0		29	10	S5601_188_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	188	0		29	10	S5601_188_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	188	0		29	10	S5601_188_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	188	0		29	10	S5601_188_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	188	0		29	10	S5601_188_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	189	0		29	10	S5601_189_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	189	0		29	10	S5601_189_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	189	0		29	10	S5601_189_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	189	0		29	10	S5601_189_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	189	0		29	10	S5601_189_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	190	0		29	10	S5601_190_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	190	0		29	10	S5601_190_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	190	0		29	10	S5601_190_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	190	0		29	10	S5601_190_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	190	0		29	10	S5601_190_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	191	0		29	10	S5601_191_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	191	0		29	10	S5601_191_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	191	0		29	10	S5601_191_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	191	0		29	10	S5601_191_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	191	0		29	10	S5601_191_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	192	0		29	10	S5601_192_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	192	0		29	10	S5601_192_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	192	0		29	10	S5601_192_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	192	0		29	10	S5601_192_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	192	0		29	10	S5601_192_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	193	0		29	10	S5601_193_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	193	0		29	10	S5601_193_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	193	0		29	10	S5601_193_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	193	0		29	10	S5601_193_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	193	0		29	10	S5601_193_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	194	0		29	10	S5601_194_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	194	0		29	10	S5601_194_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	194	0		29	10	S5601_194_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	194	0		29	10	S5601_194_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	194	0		29	10	S5601_194_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	195	0		29	10	S5601_195_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	195	0		29	10	S5601_195_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	195	0		29	10	S5601_195_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	195	0		29	10	S5601_195_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	195	0		29	10	S5601_195_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	196	0		29	10	S5601_196_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	196	0		29	10	S5601_196_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	196	0		29	10	S5601_196_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	196	0		29	10	S5601_196_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	196	0		29	10	S5601_196_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	197	0		29	10	S5601_197_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	197	0		29	10	S5601_197_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	197	0		29	10	S5601_197_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	197	0		29	10	S5601_197_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	197	0		29	10	S5601_197_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	198	0		29	10	S5601_198_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	198	0		29	10	S5601_198_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	198	0		29	10	S5601_198_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	198	0		29	10	S5601_198_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	198	0		29	10	S5601_198_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	199	0		29	10	S5601_199_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	199	0		29	10	S5601_199_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	199	0		29	10	S5601_199_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	199	0		29	10	S5601_199_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	199	0		29	10	S5601_199_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	200	0		29	10	S5601_200_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	200	0		29	10	S5601_200_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	200	0		29	10	S5601_200_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	200	0		29	10	S5601_200_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	200	0		29	10	S5601_200_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	201	0		29	10	S5601_201_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	201	0		29	10	S5601_201_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	201	0		29	10	S5601_201_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	201	0		29	10	S5601_201_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	201	0		29	10	S5601_201_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	202	0		29	10	S5601_202_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	202	0		29	10	S5601_202_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	202	0		29	10	S5601_202_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	202	0		29	10	S5601_202_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	202	0		29	10	S5601_202_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	203	0		29	10	S5601_203_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	203	0		29	10	S5601_203_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	203	0		29	10	S5601_203_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	203	0		29	10	S5601_203_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	203	0		29	10	S5601_203_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	204	0		29	10	S5601_204_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	204	0		29	10	S5601_204_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	204	0		29	10	S5601_204_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	204	0		29	10	S5601_204_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	204	0		29	10	S5601_204_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	205	0		29	10	S5601_205_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	205	0		29	10	S5601_205_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	205	0		29	10	S5601_205_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	205	0		29	10	S5601_205_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	205	0		29	10	S5601_205_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	206	0		29	10	S5601_206_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	206	0		29	10	S5601_206_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	206	0		29	10	S5601_206_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	206	0		29	10	S5601_206_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	206	0		29	10	S5601_206_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	207	0		29	10	S5601_207_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	207	0		29	10	S5601_207_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	207	0		29	10	S5601_207_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	207	0		29	10	S5601_207_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	207	0		29	10	S5601_207_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	208	0		29	10	S5601_208_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	208	0		29	10	S5601_208_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	208	0		29	10	S5601_208_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	208	0		29	10	S5601_208_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	208	0		29	10	S5601_208_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5601	209	0		29	10	S5601_209_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5601	209	0		29	10	S5601_209_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5601	209	0		29	10	S5601_209_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5601	209	0		29	10	S5601_209_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5601	209	0		29	10	S5601_209_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5609	001	0		29	10	S5609_001_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5609	001	0		29	10	S5609_001_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5609	001	0		29	10	S5609_001_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5609	001	0		29	10	S5609_001_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5609	001	0		29	10	S5609_001_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5609	002	0		29	10	S5609_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5609	002	0		29	10	S5609_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5609	002	0		29	10	S5609_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5609	002	0		29	10	S5609_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5609	002	0		29	10	S5609_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	003	0		29	10	S5617_003_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	003	0		29	10	S5617_003_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	003	0		29	10	S5617_003_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	003	0		29	10	S5617_003_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	003	0		29	10	S5617_003_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	003	0		29	10	S5617_003_0	3	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	008	0		29	10	S5617_008_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	008	0		29	10	S5617_008_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	008	0		29	10	S5617_008_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	008	0		29	10	S5617_008_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	008	0		29	10	S5617_008_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	008	0		29	10	S5617_008_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	013	0		29	10	S5617_013_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	013	0		29	10	S5617_013_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	013	0		29	10	S5617_013_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	013	0		29	10	S5617_013_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	013	0		29	10	S5617_013_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	013	0		29	10	S5617_013_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	018	0		29	10	S5617_018_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	018	0		29	10	S5617_018_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	018	0		29	10	S5617_018_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	018	0		29	10	S5617_018_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	018	0		29	10	S5617_018_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	018	0		29	10	S5617_018_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	053	0		29	10	S5617_053_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	053	0		29	10	S5617_053_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	053	0		29	10	S5617_053_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	053	0		29	10	S5617_053_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	053	0		29	10	S5617_053_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	053	0		29	10	S5617_053_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	068	0		29	10	S5617_068_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	068	0		29	10	S5617_068_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	068	0		29	10	S5617_068_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	068	0		29	10	S5617_068_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	068	0		29	10	S5617_068_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	068	0		29	10	S5617_068_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	088	0		29	10	S5617_088_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	088	0		29	10	S5617_088_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	088	0		29	10	S5617_088_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	088	0		29	10	S5617_088_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	088	0		29	10	S5617_088_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	088	0		29	10	S5617_088_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	103	0		29	10	S5617_103_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	103	0		29	10	S5617_103_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	103	0		29	10	S5617_103_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	103	0		29	10	S5617_103_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	103	0		29	10	S5617_103_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	103	0		29	10	S5617_103_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	108	0		29	10	S5617_108_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	108	0		29	10	S5617_108_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	108	0		29	10	S5617_108_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	108	0		29	10	S5617_108_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	108	0		29	10	S5617_108_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	108	0		29	10	S5617_108_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	113	0		29	10	S5617_113_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	113	0		29	10	S5617_113_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	113	0		29	10	S5617_113_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	113	0		29	10	S5617_113_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	113	0		29	10	S5617_113_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	113	0		29	10	S5617_113_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	118	0		29	10	S5617_118_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	118	0		29	10	S5617_118_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	118	0		29	10	S5617_118_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	118	0		29	10	S5617_118_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	118	0		29	10	S5617_118_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	118	0		29	10	S5617_118_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	123	0		29	10	S5617_123_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	123	0		29	10	S5617_123_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	123	0		29	10	S5617_123_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	123	0		29	10	S5617_123_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	123	0		29	10	S5617_123_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	123	0		29	10	S5617_123_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	128	0		29	10	S5617_128_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	128	0		29	10	S5617_128_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	128	0		29	10	S5617_128_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	128	0		29	10	S5617_128_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	128	0		29	10	S5617_128_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	128	0		29	10	S5617_128_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	133	0		29	10	S5617_133_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	133	0		29	10	S5617_133_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	133	0		29	10	S5617_133_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	133	0		29	10	S5617_133_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	133	0		29	10	S5617_133_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	133	0		29	10	S5617_133_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	138	0		29	10	S5617_138_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	138	0		29	10	S5617_138_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	138	0		29	10	S5617_138_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	138	0		29	10	S5617_138_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	138	0		29	10	S5617_138_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	138	0		29	10	S5617_138_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	143	0		29	10	S5617_143_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	143	0		29	10	S5617_143_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	143	0		29	10	S5617_143_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	143	0		29	10	S5617_143_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	143	0		29	10	S5617_143_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	143	0		29	10	S5617_143_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	148	0		29	10	S5617_148_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	148	0		29	10	S5617_148_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	148	0		29	10	S5617_148_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	148	0		29	10	S5617_148_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	148	0		29	10	S5617_148_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	148	0		29	10	S5617_148_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	153	0		29	10	S5617_153_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	153	0		29	10	S5617_153_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	153	0		29	10	S5617_153_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	153	0		29	10	S5617_153_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	153	0		29	10	S5617_153_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	153	0		29	10	S5617_153_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	158	0		29	10	S5617_158_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	158	0		29	10	S5617_158_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	158	0		29	10	S5617_158_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	158	0		29	10	S5617_158_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	158	0		29	10	S5617_158_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	158	0		29	10	S5617_158_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	163	0		29	10	S5617_163_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	163	0		29	10	S5617_163_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	163	0		29	10	S5617_163_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	163	0		29	10	S5617_163_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	163	0		29	10	S5617_163_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	163	0		29	10	S5617_163_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	214	0		29	10	S5617_214_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	214	0		29	10	S5617_214_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	214	0		29	10	S5617_214_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	214	0		29	10	S5617_214_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	214	0		29	10	S5617_214_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	214	0		29	10	S5617_214_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	215	0		29	10	S5617_215_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	215	0		29	10	S5617_215_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	215	0		29	10	S5617_215_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	215	0		29	10	S5617_215_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	215	0		29	10	S5617_215_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	215	0		29	10	S5617_215_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	216	0		29	10	S5617_216_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	216	0		29	10	S5617_216_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	216	0		29	10	S5617_216_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	216	0		29	10	S5617_216_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	216	0		29	10	S5617_216_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	216	0		29	10	S5617_216_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	217	0		29	10	S5617_217_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	217	0		29	10	S5617_217_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	217	0		29	10	S5617_217_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	217	0		29	10	S5617_217_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	217	0		29	10	S5617_217_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	217	0		29	10	S5617_217_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	218	0		29	10	S5617_218_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	218	0		29	10	S5617_218_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	218	0		29	10	S5617_218_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	218	0		29	10	S5617_218_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	218	0		29	10	S5617_218_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	218	0		29	10	S5617_218_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	219	0		29	10	S5617_219_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	219	0		29	10	S5617_219_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	219	0		29	10	S5617_219_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	219	0		29	10	S5617_219_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	219	0		29	10	S5617_219_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	219	0		29	10	S5617_219_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	220	0		29	10	S5617_220_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	220	0		29	10	S5617_220_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	220	0		29	10	S5617_220_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	220	0		29	10	S5617_220_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	220	0		29	10	S5617_220_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	220	0		29	10	S5617_220_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	221	0		29	10	S5617_221_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	221	0		29	10	S5617_221_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	221	0		29	10	S5617_221_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	221	0		29	10	S5617_221_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	221	0		29	10	S5617_221_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	221	0		29	10	S5617_221_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	222	0		29	10	S5617_222_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	222	0		29	10	S5617_222_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	222	0		29	10	S5617_222_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	222	0		29	10	S5617_222_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	222	0		29	10	S5617_222_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	222	0		29	10	S5617_222_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	223	0		29	10	S5617_223_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	223	0		29	10	S5617_223_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	223	0		29	10	S5617_223_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	223	0		29	10	S5617_223_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	223	0		29	10	S5617_223_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	223	0		29	10	S5617_223_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	224	0		29	10	S5617_224_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	224	0		29	10	S5617_224_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	224	0		29	10	S5617_224_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	224	0		29	10	S5617_224_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	224	0		29	10	S5617_224_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	224	0		29	10	S5617_224_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	225	0		29	10	S5617_225_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	225	0		29	10	S5617_225_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	225	0		29	10	S5617_225_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	225	0		29	10	S5617_225_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	225	0		29	10	S5617_225_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	225	0		29	10	S5617_225_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	226	0		29	10	S5617_226_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	226	0		29	10	S5617_226_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	226	0		29	10	S5617_226_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	226	0		29	10	S5617_226_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	226	0		29	10	S5617_226_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	226	0		29	10	S5617_226_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	227	0		29	10	S5617_227_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	227	0		29	10	S5617_227_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	227	0		29	10	S5617_227_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	227	0		29	10	S5617_227_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	227	0		29	10	S5617_227_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	227	0		29	10	S5617_227_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	246	0		29	10	S5617_246_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	246	0		29	10	S5617_246_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	246	0		29	10	S5617_246_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	246	0		29	10	S5617_246_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	246	0		29	10	S5617_246_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	246	0		29	10	S5617_246_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	247	0		29	10	S5617_247_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	247	0		29	10	S5617_247_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	247	0		29	10	S5617_247_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	247	0		29	10	S5617_247_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	247	0		29	10	S5617_247_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	247	0		29	10	S5617_247_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	248	0		29	10	S5617_248_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	248	0		29	10	S5617_248_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	248	0		29	10	S5617_248_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	248	0		29	10	S5617_248_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	248	0		29	10	S5617_248_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	248	0		29	10	S5617_248_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	249	0		29	10	S5617_249_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	249	0		29	10	S5617_249_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	249	0		29	10	S5617_249_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	249	0		29	10	S5617_249_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	249	0		29	10	S5617_249_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	249	0		29	10	S5617_249_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	250	0		29	10	S5617_250_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	250	0		29	10	S5617_250_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	250	0		29	10	S5617_250_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	250	0		29	10	S5617_250_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	250	0		29	10	S5617_250_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	250	0		29	10	S5617_250_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	251	0		29	10	S5617_251_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	251	0		29	10	S5617_251_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	251	0		29	10	S5617_251_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	251	0		29	10	S5617_251_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	251	0		29	10	S5617_251_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	251	0		29	10	S5617_251_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	252	0		29	10	S5617_252_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	252	0		29	10	S5617_252_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	252	0		29	10	S5617_252_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	252	0		29	10	S5617_252_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	252	0		29	10	S5617_252_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	252	0		29	10	S5617_252_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	253	0		29	10	S5617_253_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	253	0		29	10	S5617_253_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	253	0		29	10	S5617_253_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	253	0		29	10	S5617_253_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	253	0		29	10	S5617_253_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	253	0		29	10	S5617_253_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	254	0		29	10	S5617_254_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	254	0		29	10	S5617_254_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	254	0		29	10	S5617_254_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	254	0		29	10	S5617_254_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	254	0		29	10	S5617_254_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	254	0		29	10	S5617_254_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	255	0		29	10	S5617_255_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	255	0		29	10	S5617_255_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	255	0		29	10	S5617_255_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	255	0		29	10	S5617_255_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	255	0		29	10	S5617_255_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	255	0		29	10	S5617_255_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	256	0		29	10	S5617_256_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	256	0		29	10	S5617_256_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	256	0		29	10	S5617_256_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	256	0		29	10	S5617_256_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	256	0		29	10	S5617_256_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	256	0		29	10	S5617_256_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	257	0		29	10	S5617_257_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	257	0		29	10	S5617_257_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	257	0		29	10	S5617_257_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	257	0		29	10	S5617_257_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	257	0		29	10	S5617_257_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	257	0		29	10	S5617_257_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	258	0		29	10	S5617_258_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	258	0		29	10	S5617_258_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	258	0		29	10	S5617_258_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	258	0		29	10	S5617_258_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	258	0		29	10	S5617_258_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	258	0		29	10	S5617_258_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	259	0		29	10	S5617_259_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	259	0		29	10	S5617_259_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	259	0		29	10	S5617_259_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	259	0		29	10	S5617_259_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	259	0		29	10	S5617_259_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	259	0		29	10	S5617_259_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	260	0		29	10	S5617_260_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	260	0		29	10	S5617_260_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	260	0		29	10	S5617_260_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	260	0		29	10	S5617_260_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	260	0		29	10	S5617_260_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	260	0		29	10	S5617_260_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	261	0		29	10	S5617_261_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	261	0		29	10	S5617_261_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	261	0		29	10	S5617_261_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	261	0		29	10	S5617_261_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	261	0		29	10	S5617_261_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	261	0		29	10	S5617_261_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	262	0		29	10	S5617_262_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	262	0		29	10	S5617_262_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	262	0		29	10	S5617_262_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	262	0		29	10	S5617_262_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	262	0		29	10	S5617_262_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	262	0		29	10	S5617_262_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	263	0		29	10	S5617_263_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	263	0		29	10	S5617_263_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	263	0		29	10	S5617_263_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	263	0		29	10	S5617_263_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	263	0		29	10	S5617_263_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	263	0		29	10	S5617_263_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	264	0		29	10	S5617_264_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	264	0		29	10	S5617_264_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	264	0		29	10	S5617_264_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	264	0		29	10	S5617_264_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	264	0		29	10	S5617_264_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	264	0		29	10	S5617_264_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	265	0		29	10	S5617_265_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	265	0		29	10	S5617_265_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	265	0		29	10	S5617_265_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	265	0		29	10	S5617_265_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	265	0		29	10	S5617_265_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	265	0		29	10	S5617_265_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	266	0		29	10	S5617_266_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	266	0		29	10	S5617_266_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	266	0		29	10	S5617_266_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	266	0		29	10	S5617_266_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	266	0		29	10	S5617_266_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	266	0		29	10	S5617_266_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	267	0		29	10	S5617_267_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	267	0		29	10	S5617_267_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	267	0		29	10	S5617_267_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	267	0		29	10	S5617_267_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	267	0		29	10	S5617_267_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	267	0		29	10	S5617_267_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	268	0		29	10	S5617_268_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	268	0		29	10	S5617_268_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	268	0		29	10	S5617_268_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	268	0		29	10	S5617_268_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	268	0		29	10	S5617_268_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	268	0		29	10	S5617_268_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	269	0		29	10	S5617_269_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	269	0		29	10	S5617_269_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	269	0		29	10	S5617_269_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	269	0		29	10	S5617_269_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	269	0		29	10	S5617_269_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	269	0		29	10	S5617_269_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	270	0		29	10	S5617_270_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	270	0		29	10	S5617_270_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	270	0		29	10	S5617_270_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	270	0		29	10	S5617_270_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	270	0		29	10	S5617_270_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	270	0		29	10	S5617_270_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	271	0		29	10	S5617_271_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	271	0		29	10	S5617_271_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	271	0		29	10	S5617_271_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	271	0		29	10	S5617_271_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	271	0		29	10	S5617_271_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	271	0		29	10	S5617_271_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	272	0		29	10	S5617_272_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	272	0		29	10	S5617_272_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	272	0		29	10	S5617_272_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	272	0		29	10	S5617_272_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	272	0		29	10	S5617_272_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	272	0		29	10	S5617_272_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	273	0		29	10	S5617_273_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	273	0		29	10	S5617_273_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	273	0		29	10	S5617_273_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	273	0		29	10	S5617_273_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	273	0		29	10	S5617_273_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	273	0		29	10	S5617_273_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	274	0		29	10	S5617_274_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	274	0		29	10	S5617_274_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	274	0		29	10	S5617_274_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	274	0		29	10	S5617_274_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	274	0		29	10	S5617_274_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	274	0		29	10	S5617_274_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	275	0		29	10	S5617_275_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	275	0		29	10	S5617_275_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	275	0		29	10	S5617_275_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	275	0		29	10	S5617_275_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	275	0		29	10	S5617_275_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	275	0		29	10	S5617_275_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	276	0		29	10	S5617_276_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	276	0		29	10	S5617_276_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	276	0		29	10	S5617_276_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	276	0		29	10	S5617_276_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	276	0		29	10	S5617_276_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	276	0		29	10	S5617_276_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	277	0		29	10	S5617_277_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	277	0		29	10	S5617_277_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	277	0		29	10	S5617_277_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	277	0		29	10	S5617_277_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	277	0		29	10	S5617_277_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	277	0		29	10	S5617_277_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	278	0		29	10	S5617_278_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	278	0		29	10	S5617_278_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	278	0		29	10	S5617_278_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	278	0		29	10	S5617_278_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	278	0		29	10	S5617_278_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	278	0		29	10	S5617_278_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	279	0		29	10	S5617_279_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5617	279	0		29	10	S5617_279_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5617	279	0		29	10	S5617_279_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5617	279	0		29	10	S5617_279_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5617	279	0		29	10	S5617_279_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5617	279	0		29	10	S5617_279_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5617	280	0		29	10	S5617_280_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	280	0		29	10	S5617_280_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	280	0		29	10	S5617_280_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	280	0		29	10	S5617_280_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	280	0		29	10	S5617_280_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	281	0		29	10	S5617_281_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	281	0		29	10	S5617_281_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	281	0		29	10	S5617_281_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	281	0		29	10	S5617_281_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	281	0		29	10	S5617_281_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	282	0		29	10	S5617_282_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	282	0		29	10	S5617_282_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	282	0		29	10	S5617_282_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	282	0		29	10	S5617_282_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	282	0		29	10	S5617_282_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	283	0		29	10	S5617_283_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	283	0		29	10	S5617_283_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	283	0		29	10	S5617_283_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	283	0		29	10	S5617_283_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	283	0		29	10	S5617_283_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	284	0		29	10	S5617_284_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	284	0		29	10	S5617_284_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	284	0		29	10	S5617_284_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	284	0		29	10	S5617_284_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	284	0		29	10	S5617_284_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	285	0		29	10	S5617_285_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	285	0		29	10	S5617_285_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	285	0		29	10	S5617_285_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	285	0		29	10	S5617_285_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	285	0		29	10	S5617_285_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	286	0		29	10	S5617_286_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	286	0		29	10	S5617_286_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	286	0		29	10	S5617_286_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	286	0		29	10	S5617_286_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	286	0		29	10	S5617_286_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	287	0		29	10	S5617_287_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	287	0		29	10	S5617_287_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	287	0		29	10	S5617_287_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	287	0		29	10	S5617_287_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	287	0		29	10	S5617_287_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	288	0		29	10	S5617_288_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	288	0		29	10	S5617_288_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	288	0		29	10	S5617_288_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	288	0		29	10	S5617_288_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	288	0		29	10	S5617_288_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	289	0		29	10	S5617_289_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	289	0		29	10	S5617_289_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	289	0		29	10	S5617_289_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	289	0		29	10	S5617_289_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	289	0		29	10	S5617_289_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	290	0		29	10	S5617_290_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	290	0		29	10	S5617_290_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	290	0		29	10	S5617_290_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	290	0		29	10	S5617_290_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	290	0		29	10	S5617_290_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	291	0		29	10	S5617_291_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	291	0		29	10	S5617_291_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	291	0		29	10	S5617_291_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	291	0		29	10	S5617_291_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	291	0		29	10	S5617_291_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	292	0		29	10	S5617_292_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	292	0		29	10	S5617_292_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	292	0		29	10	S5617_292_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	292	0		29	10	S5617_292_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	292	0		29	10	S5617_292_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	293	0		29	10	S5617_293_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	293	0		29	10	S5617_293_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	293	0		29	10	S5617_293_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	293	0		29	10	S5617_293_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	293	0		29	10	S5617_293_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	294	0		29	10	S5617_294_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	294	0		29	10	S5617_294_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	294	0		29	10	S5617_294_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	294	0		29	10	S5617_294_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	294	0		29	10	S5617_294_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	295	0		29	10	S5617_295_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	295	0		29	10	S5617_295_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	295	0		29	10	S5617_295_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	295	0		29	10	S5617_295_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	295	0		29	10	S5617_295_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	296	0		29	10	S5617_296_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	296	0		29	10	S5617_296_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	296	0		29	10	S5617_296_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	296	0		29	10	S5617_296_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	296	0		29	10	S5617_296_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	297	0		29	10	S5617_297_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	297	0		29	10	S5617_297_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	297	0		29	10	S5617_297_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	297	0		29	10	S5617_297_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	297	0		29	10	S5617_297_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	298	0		29	10	S5617_298_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	298	0		29	10	S5617_298_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	298	0		29	10	S5617_298_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	298	0		29	10	S5617_298_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	298	0		29	10	S5617_298_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	299	0		29	10	S5617_299_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	299	0		29	10	S5617_299_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	299	0		29	10	S5617_299_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	299	0		29	10	S5617_299_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	299	0		29	10	S5617_299_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	300	0		29	10	S5617_300_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	300	0		29	10	S5617_300_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	300	0		29	10	S5617_300_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	300	0		29	10	S5617_300_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	300	0		29	10	S5617_300_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	301	0		29	10	S5617_301_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	301	0		29	10	S5617_301_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	301	0		29	10	S5617_301_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	301	0		29	10	S5617_301_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	301	0		29	10	S5617_301_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	302	0		29	10	S5617_302_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	302	0		29	10	S5617_302_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	302	0		29	10	S5617_302_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	302	0		29	10	S5617_302_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	302	0		29	10	S5617_302_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	303	0		29	10	S5617_303_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	303	0		29	10	S5617_303_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	303	0		29	10	S5617_303_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	303	0		29	10	S5617_303_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	303	0		29	10	S5617_303_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	304	0		29	10	S5617_304_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	304	0		29	10	S5617_304_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	304	0		29	10	S5617_304_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	304	0		29	10	S5617_304_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	304	0		29	10	S5617_304_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	305	0		29	10	S5617_305_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	305	0		29	10	S5617_305_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	305	0		29	10	S5617_305_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	305	0		29	10	S5617_305_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	305	0		29	10	S5617_305_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	306	0		29	10	S5617_306_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	306	0		29	10	S5617_306_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	306	0		29	10	S5617_306_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	306	0		29	10	S5617_306_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	306	0		29	10	S5617_306_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	307	0		29	10	S5617_307_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	307	0		29	10	S5617_307_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	307	0		29	10	S5617_307_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	307	0		29	10	S5617_307_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	307	0		29	10	S5617_307_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	308	0		29	10	S5617_308_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	308	0		29	10	S5617_308_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	308	0		29	10	S5617_308_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	308	0		29	10	S5617_308_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	308	0		29	10	S5617_308_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	309	0		29	10	S5617_309_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	309	0		29	10	S5617_309_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	309	0		29	10	S5617_309_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	309	0		29	10	S5617_309_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	309	0		29	10	S5617_309_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	310	0		29	10	S5617_310_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	310	0		29	10	S5617_310_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	310	0		29	10	S5617_310_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	310	0		29	10	S5617_310_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	310	0		29	10	S5617_310_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	311	0		29	10	S5617_311_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	311	0		29	10	S5617_311_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	311	0		29	10	S5617_311_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	311	0		29	10	S5617_311_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	311	0		29	10	S5617_311_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	312	0		29	10	S5617_312_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	312	0		29	10	S5617_312_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	312	0		29	10	S5617_312_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	312	0		29	10	S5617_312_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	312	0		29	10	S5617_312_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5617	313	0		29	10	S5617_313_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5617	313	0		29	10	S5617_313_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5617	313	0		29	10	S5617_313_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5617	313	0		29	10	S5617_313_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5617	313	0		29	10	S5617_313_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	104	0		29	10	S5660_104_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	104	0		29	10	S5660_104_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	104	0		29	10	S5660_104_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	104	0		29	10	S5660_104_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	104	0		29	10	S5660_104_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	104	0		29	10	S5660_104_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	105	0		29	10	S5660_105_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	105	0		29	10	S5660_105_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	105	0		29	10	S5660_105_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	105	0		29	10	S5660_105_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	105	0		29	10	S5660_105_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	105	0		29	10	S5660_105_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	106	0		29	10	S5660_106_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	106	0		29	10	S5660_106_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	106	0		29	10	S5660_106_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	106	0		29	10	S5660_106_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	106	0		29	10	S5660_106_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	106	0		29	10	S5660_106_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	107	0		29	10	S5660_107_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	107	0		29	10	S5660_107_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	107	0		29	10	S5660_107_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	107	0		29	10	S5660_107_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	107	0		29	10	S5660_107_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	107	0		29	10	S5660_107_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	108	0		29	10	S5660_108_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	108	0		29	10	S5660_108_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	108	0		29	10	S5660_108_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	108	0		29	10	S5660_108_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	108	0		29	10	S5660_108_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	108	0		29	10	S5660_108_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	109	0		29	10	S5660_109_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	109	0		29	10	S5660_109_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	109	0		29	10	S5660_109_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	109	0		29	10	S5660_109_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	109	0		29	10	S5660_109_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	109	0		29	10	S5660_109_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	110	0		29	10	S5660_110_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	110	0		29	10	S5660_110_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	110	0		29	10	S5660_110_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	110	0		29	10	S5660_110_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	110	0		29	10	S5660_110_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	110	0		29	10	S5660_110_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	111	0		29	10	S5660_111_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	111	0		29	10	S5660_111_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	111	0		29	10	S5660_111_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	111	0		29	10	S5660_111_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	111	0		29	10	S5660_111_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	111	0		29	10	S5660_111_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	112	0		29	10	S5660_112_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	112	0		29	10	S5660_112_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	112	0		29	10	S5660_112_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	112	0		29	10	S5660_112_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	112	0		29	10	S5660_112_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	112	0		29	10	S5660_112_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	113	0		29	10	S5660_113_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	113	0		29	10	S5660_113_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	113	0		29	10	S5660_113_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	113	0		29	10	S5660_113_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	113	0		29	10	S5660_113_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	113	0		29	10	S5660_113_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	114	0		29	10	S5660_114_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	114	0		29	10	S5660_114_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	114	0		29	10	S5660_114_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	114	0		29	10	S5660_114_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	114	0		29	10	S5660_114_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	114	0		29	10	S5660_114_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	115	0		29	10	S5660_115_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	115	0		29	10	S5660_115_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	115	0		29	10	S5660_115_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	115	0		29	10	S5660_115_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	115	0		29	10	S5660_115_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	115	0		29	10	S5660_115_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	116	0		29	10	S5660_116_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	116	0		29	10	S5660_116_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	116	0		29	10	S5660_116_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	116	0		29	10	S5660_116_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	116	0		29	10	S5660_116_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	116	0		29	10	S5660_116_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	117	0		29	10	S5660_117_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	117	0		29	10	S5660_117_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	117	0		29	10	S5660_117_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	117	0		29	10	S5660_117_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	117	0		29	10	S5660_117_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	117	0		29	10	S5660_117_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	118	0		29	10	S5660_118_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	118	0		29	10	S5660_118_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	118	0		29	10	S5660_118_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	118	0		29	10	S5660_118_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	118	0		29	10	S5660_118_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	118	0		29	10	S5660_118_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	119	0		29	10	S5660_119_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	119	0		29	10	S5660_119_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	119	0		29	10	S5660_119_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	119	0		29	10	S5660_119_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	119	0		29	10	S5660_119_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	119	0		29	10	S5660_119_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	120	0		29	10	S5660_120_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	120	0		29	10	S5660_120_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	120	0		29	10	S5660_120_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	120	0		29	10	S5660_120_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	120	0		29	10	S5660_120_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	120	0		29	10	S5660_120_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	121	0		29	10	S5660_121_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	121	0		29	10	S5660_121_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	121	0		29	10	S5660_121_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	121	0		29	10	S5660_121_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	121	0		29	10	S5660_121_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	121	0		29	10	S5660_121_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	122	0		29	10	S5660_122_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	122	0		29	10	S5660_122_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	122	0		29	10	S5660_122_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	122	0		29	10	S5660_122_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	122	0		29	10	S5660_122_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	122	0		29	10	S5660_122_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	123	0		29	10	S5660_123_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	123	0		29	10	S5660_123_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	123	0		29	10	S5660_123_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	123	0		29	10	S5660_123_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	123	0		29	10	S5660_123_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	123	0		29	10	S5660_123_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	124	0		29	10	S5660_124_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	124	0		29	10	S5660_124_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	124	0		29	10	S5660_124_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	124	0		29	10	S5660_124_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	124	0		29	10	S5660_124_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	124	0		29	10	S5660_124_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	125	0		29	10	S5660_125_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	125	0		29	10	S5660_125_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	125	0		29	10	S5660_125_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	125	0		29	10	S5660_125_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	125	0		29	10	S5660_125_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	125	0		29	10	S5660_125_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	126	0		29	10	S5660_126_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	126	0		29	10	S5660_126_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	126	0		29	10	S5660_126_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	126	0		29	10	S5660_126_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	126	0		29	10	S5660_126_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	126	0		29	10	S5660_126_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	127	0		29	10	S5660_127_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	127	0		29	10	S5660_127_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	127	0		29	10	S5660_127_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	127	0		29	10	S5660_127_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	127	0		29	10	S5660_127_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	127	0		29	10	S5660_127_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	128	0		29	10	S5660_128_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	128	0		29	10	S5660_128_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	128	0		29	10	S5660_128_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	128	0		29	10	S5660_128_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	128	0		29	10	S5660_128_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	128	0		29	10	S5660_128_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	129	0		29	10	S5660_129_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	129	0		29	10	S5660_129_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	129	0		29	10	S5660_129_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	129	0		29	10	S5660_129_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	129	0		29	10	S5660_129_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	129	0		29	10	S5660_129_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	130	0		29	10	S5660_130_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	130	0		29	10	S5660_130_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	130	0		29	10	S5660_130_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	130	0		29	10	S5660_130_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	130	0		29	10	S5660_130_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	130	0		29	10	S5660_130_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	131	0		29	10	S5660_131_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	131	0		29	10	S5660_131_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	131	0		29	10	S5660_131_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	131	0		29	10	S5660_131_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	131	0		29	10	S5660_131_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	131	0		29	10	S5660_131_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	132	0		29	10	S5660_132_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	132	0		29	10	S5660_132_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	132	0		29	10	S5660_132_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	132	0		29	10	S5660_132_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	132	0		29	10	S5660_132_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	132	0		29	10	S5660_132_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	133	0		29	10	S5660_133_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	133	0		29	10	S5660_133_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	133	0		29	10	S5660_133_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	133	0		29	10	S5660_133_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	133	0		29	10	S5660_133_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	133	0		29	10	S5660_133_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	134	0		29	10	S5660_134_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	134	0		29	10	S5660_134_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	134	0		29	10	S5660_134_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	134	0		29	10	S5660_134_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	134	0		29	10	S5660_134_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	134	0		29	10	S5660_134_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	135	0		29	10	S5660_135_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	135	0		29	10	S5660_135_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	135	0		29	10	S5660_135_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	135	0		29	10	S5660_135_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	135	0		29	10	S5660_135_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	135	0		29	10	S5660_135_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	136	0		29	10	S5660_136_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	136	0		29	10	S5660_136_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	136	0		29	10	S5660_136_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	136	0		29	10	S5660_136_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	136	0		29	10	S5660_136_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	136	0		29	10	S5660_136_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	137	0		29	10	S5660_137_0	1	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	137	0		29	10	S5660_137_0	1	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	137	0		29	10	S5660_137_0	1	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	137	0		29	10	S5660_137_0	1	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	137	0		29	10	S5660_137_0	1	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	137	0		29	10	S5660_137_0	1	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	172	0		29	10	S5660_172_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	172	0		29	10	S5660_172_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	172	0		29	10	S5660_172_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	172	0		29	10	S5660_172_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	172	0		29	10	S5660_172_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	172	0		29	10	S5660_172_0	2	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	176	0		29	10	S5660_176_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	176	0		29	10	S5660_176_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	176	0		29	10	S5660_176_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	176	0		29	10	S5660_176_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	176	0		29	10	S5660_176_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	176	0		29	10	S5660_176_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	180	0		29	10	S5660_180_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	180	0		29	10	S5660_180_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	180	0		29	10	S5660_180_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	180	0		29	10	S5660_180_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	180	0		29	10	S5660_180_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	180	0		29	10	S5660_180_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	181	0		29	10	S5660_181_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	181	0		29	10	S5660_181_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	181	0		29	10	S5660_181_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	181	0		29	10	S5660_181_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	181	0		29	10	S5660_181_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	181	0		29	10	S5660_181_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	182	0		29	10	S5660_182_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	182	0		29	10	S5660_182_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	182	0		29	10	S5660_182_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	182	0		29	10	S5660_182_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	182	0		29	10	S5660_182_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	182	0		29	10	S5660_182_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	183	0		29	10	S5660_183_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	183	0		29	10	S5660_183_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	183	0		29	10	S5660_183_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	183	0		29	10	S5660_183_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	183	0		29	10	S5660_183_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	183	0		29	10	S5660_183_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	184	0		29	10	S5660_184_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	184	0		29	10	S5660_184_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	184	0		29	10	S5660_184_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	184	0		29	10	S5660_184_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	184	0		29	10	S5660_184_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	184	0		29	10	S5660_184_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	185	0		29	10	S5660_185_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	185	0		29	10	S5660_185_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	185	0		29	10	S5660_185_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	185	0		29	10	S5660_185_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	185	0		29	10	S5660_185_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	185	0		29	10	S5660_185_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	186	0		29	10	S5660_186_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	186	0		29	10	S5660_186_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	186	0		29	10	S5660_186_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	186	0		29	10	S5660_186_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	186	0		29	10	S5660_186_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	186	0		29	10	S5660_186_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	187	0		29	10	S5660_187_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	187	0		29	10	S5660_187_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	187	0		29	10	S5660_187_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	187	0		29	10	S5660_187_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	187	0		29	10	S5660_187_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	187	0		29	10	S5660_187_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	190	0		29	10	S5660_190_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	190	0		29	10	S5660_190_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	190	0		29	10	S5660_190_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	190	0		29	10	S5660_190_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	190	0		29	10	S5660_190_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	190	0		29	10	S5660_190_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	192	0		29	10	S5660_192_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	192	0		29	10	S5660_192_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	192	0		29	10	S5660_192_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	192	0		29	10	S5660_192_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	192	0		29	10	S5660_192_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	192	0		29	10	S5660_192_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	194	0		29	10	S5660_194_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	194	0		29	10	S5660_194_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	194	0		29	10	S5660_194_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	194	0		29	10	S5660_194_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	194	0		29	10	S5660_194_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	194	0		29	10	S5660_194_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	195	0		29	10	S5660_195_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	195	0		29	10	S5660_195_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	195	0		29	10	S5660_195_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	195	0		29	10	S5660_195_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	195	0		29	10	S5660_195_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	195	0		29	10	S5660_195_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	196	0		29	10	S5660_196_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	196	0		29	10	S5660_196_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	196	0		29	10	S5660_196_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	196	0		29	10	S5660_196_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	196	0		29	10	S5660_196_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	196	0		29	10	S5660_196_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	197	0		29	10	S5660_197_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	197	0		29	10	S5660_197_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	197	0		29	10	S5660_197_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	197	0		29	10	S5660_197_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	197	0		29	10	S5660_197_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	197	0		29	10	S5660_197_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	198	0		29	10	S5660_198_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	198	0		29	10	S5660_198_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	198	0		29	10	S5660_198_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	198	0		29	10	S5660_198_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	198	0		29	10	S5660_198_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	198	0		29	10	S5660_198_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	199	0		29	10	S5660_199_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	199	0		29	10	S5660_199_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	199	0		29	10	S5660_199_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	199	0		29	10	S5660_199_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	199	0		29	10	S5660_199_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	199	0		29	10	S5660_199_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	202	0		29	10	S5660_202_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	202	0		29	10	S5660_202_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	202	0		29	10	S5660_202_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	202	0		29	10	S5660_202_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	202	0		29	10	S5660_202_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	202	0		29	10	S5660_202_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	203	0		29	10	S5660_203_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	203	0		29	10	S5660_203_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	203	0		29	10	S5660_203_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	203	0		29	10	S5660_203_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	203	0		29	10	S5660_203_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	203	0		29	10	S5660_203_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	204	0		29	10	S5660_204_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	204	0		29	10	S5660_204_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	204	0		29	10	S5660_204_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	204	0		29	10	S5660_204_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	204	0		29	10	S5660_204_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	204	0		29	10	S5660_204_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	206	0		29	10	S5660_206_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	206	0		29	10	S5660_206_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	206	0		29	10	S5660_206_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	206	0		29	10	S5660_206_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	206	0		29	10	S5660_206_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	206	0		29	10	S5660_206_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	207	0		29	10	S5660_207_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	207	0		29	10	S5660_207_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	207	0		29	10	S5660_207_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	207	0		29	10	S5660_207_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	207	0		29	10	S5660_207_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	207	0		29	10	S5660_207_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	208	0		29	10	S5660_208_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	208	0		29	10	S5660_208_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	208	0		29	10	S5660_208_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	208	0		29	10	S5660_208_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	208	0		29	10	S5660_208_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	208	0		29	10	S5660_208_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	209	0		29	10	S5660_209_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	209	0		29	10	S5660_209_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	209	0		29	10	S5660_209_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	209	0		29	10	S5660_209_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	209	0		29	10	S5660_209_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	209	0		29	10	S5660_209_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	210	0		29	10	S5660_210_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	210	0		29	10	S5660_210_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	210	0		29	10	S5660_210_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	210	0		29	10	S5660_210_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	210	0		29	10	S5660_210_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	210	0		29	10	S5660_210_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	211	0		29	10	S5660_211_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	211	0		29	10	S5660_211_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	211	0		29	10	S5660_211_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	211	0		29	10	S5660_211_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	211	0		29	10	S5660_211_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	211	0		29	10	S5660_211_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	212	0		29	10	S5660_212_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	212	0		29	10	S5660_212_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	212	0		29	10	S5660_212_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	212	0		29	10	S5660_212_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	212	0		29	10	S5660_212_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	212	0		29	10	S5660_212_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	213	0		29	10	S5660_213_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	213	0		29	10	S5660_213_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	213	0		29	10	S5660_213_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	213	0		29	10	S5660_213_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	213	0		29	10	S5660_213_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	213	0		29	10	S5660_213_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	214	0		29	10	S5660_214_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	214	0		29	10	S5660_214_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	214	0		29	10	S5660_214_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	214	0		29	10	S5660_214_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	214	0		29	10	S5660_214_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	214	0		29	10	S5660_214_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	215	0		29	10	S5660_215_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	215	0		29	10	S5660_215_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	215	0		29	10	S5660_215_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	215	0		29	10	S5660_215_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	215	0		29	10	S5660_215_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	215	0		29	10	S5660_215_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	216	0		29	10	S5660_216_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	216	0		29	10	S5660_216_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	216	0		29	10	S5660_216_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	216	0		29	10	S5660_216_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	216	0		29	10	S5660_216_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	216	0		29	10	S5660_216_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	217	0		29	10	S5660_217_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5660	217	0		29	10	S5660_217_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5660	217	0		29	10	S5660_217_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5660	217	0		29	10	S5660_217_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5660	217	0		29	10	S5660_217_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5660	217	0		29	10	S5660_217_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5660	218	0		29	10	S5660_218_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	218	0		29	10	S5660_218_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	218	0		29	10	S5660_218_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	218	0		29	10	S5660_218_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	218	0		29	10	S5660_218_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	219	0		29	10	S5660_219_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	219	0		29	10	S5660_219_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	219	0		29	10	S5660_219_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	219	0		29	10	S5660_219_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	219	0		29	10	S5660_219_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	220	0		29	10	S5660_220_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	220	0		29	10	S5660_220_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	220	0		29	10	S5660_220_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	220	0		29	10	S5660_220_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	220	0		29	10	S5660_220_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	221	0		29	10	S5660_221_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	221	0		29	10	S5660_221_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	221	0		29	10	S5660_221_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	221	0		29	10	S5660_221_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	221	0		29	10	S5660_221_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	222	0		29	10	S5660_222_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	222	0		29	10	S5660_222_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	222	0		29	10	S5660_222_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	222	0		29	10	S5660_222_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	222	0		29	10	S5660_222_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	223	0		29	10	S5660_223_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	223	0		29	10	S5660_223_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	223	0		29	10	S5660_223_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	223	0		29	10	S5660_223_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	223	0		29	10	S5660_223_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	224	0		29	10	S5660_224_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	224	0		29	10	S5660_224_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	224	0		29	10	S5660_224_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	224	0		29	10	S5660_224_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	224	0		29	10	S5660_224_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	225	0		29	10	S5660_225_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	225	0		29	10	S5660_225_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	225	0		29	10	S5660_225_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	225	0		29	10	S5660_225_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	225	0		29	10	S5660_225_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	226	0		29	10	S5660_226_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	226	0		29	10	S5660_226_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	226	0		29	10	S5660_226_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	226	0		29	10	S5660_226_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	226	0		29	10	S5660_226_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	227	0		29	10	S5660_227_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	227	0		29	10	S5660_227_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	227	0		29	10	S5660_227_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	227	0		29	10	S5660_227_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	227	0		29	10	S5660_227_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	228	0		29	10	S5660_228_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	228	0		29	10	S5660_228_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	228	0		29	10	S5660_228_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	228	0		29	10	S5660_228_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	228	0		29	10	S5660_228_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	229	0		29	10	S5660_229_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	229	0		29	10	S5660_229_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	229	0		29	10	S5660_229_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	229	0		29	10	S5660_229_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	229	0		29	10	S5660_229_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	230	0		29	10	S5660_230_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	230	0		29	10	S5660_230_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	230	0		29	10	S5660_230_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	230	0		29	10	S5660_230_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	230	0		29	10	S5660_230_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	231	0		29	10	S5660_231_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	231	0		29	10	S5660_231_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	231	0		29	10	S5660_231_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	231	0		29	10	S5660_231_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	231	0		29	10	S5660_231_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	232	0		29	10	S5660_232_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	232	0		29	10	S5660_232_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	232	0		29	10	S5660_232_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	232	0		29	10	S5660_232_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	232	0		29	10	S5660_232_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	233	0		29	10	S5660_233_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	233	0		29	10	S5660_233_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	233	0		29	10	S5660_233_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	233	0		29	10	S5660_233_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	233	0		29	10	S5660_233_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	234	0		29	10	S5660_234_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	234	0		29	10	S5660_234_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	234	0		29	10	S5660_234_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	234	0		29	10	S5660_234_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	234	0		29	10	S5660_234_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	235	0		29	10	S5660_235_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	235	0		29	10	S5660_235_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	235	0		29	10	S5660_235_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	235	0		29	10	S5660_235_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	235	0		29	10	S5660_235_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	236	0		29	10	S5660_236_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	236	0		29	10	S5660_236_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	236	0		29	10	S5660_236_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	236	0		29	10	S5660_236_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	236	0		29	10	S5660_236_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	237	0		29	10	S5660_237_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	237	0		29	10	S5660_237_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	237	0		29	10	S5660_237_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	237	0		29	10	S5660_237_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	237	0		29	10	S5660_237_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	238	0		29	10	S5660_238_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	238	0		29	10	S5660_238_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	238	0		29	10	S5660_238_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	238	0		29	10	S5660_238_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	238	0		29	10	S5660_238_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	239	0		29	10	S5660_239_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	239	0		29	10	S5660_239_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	239	0		29	10	S5660_239_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	239	0		29	10	S5660_239_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	239	0		29	10	S5660_239_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	240	0		29	10	S5660_240_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	240	0		29	10	S5660_240_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	240	0		29	10	S5660_240_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	240	0		29	10	S5660_240_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	240	0		29	10	S5660_240_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	241	0		29	10	S5660_241_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	241	0		29	10	S5660_241_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	241	0		29	10	S5660_241_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	241	0		29	10	S5660_241_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	241	0		29	10	S5660_241_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	242	0		29	10	S5660_242_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	242	0		29	10	S5660_242_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	242	0		29	10	S5660_242_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	242	0		29	10	S5660_242_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	242	0		29	10	S5660_242_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	243	0		29	10	S5660_243_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	243	0		29	10	S5660_243_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	243	0		29	10	S5660_243_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	243	0		29	10	S5660_243_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	243	0		29	10	S5660_243_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	244	0		29	10	S5660_244_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	244	0		29	10	S5660_244_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	244	0		29	10	S5660_244_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	244	0		29	10	S5660_244_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	244	0		29	10	S5660_244_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	245	0		29	10	S5660_245_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	245	0		29	10	S5660_245_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	245	0		29	10	S5660_245_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	245	0		29	10	S5660_245_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	245	0		29	10	S5660_245_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	246	0		29	10	S5660_246_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	246	0		29	10	S5660_246_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	246	0		29	10	S5660_246_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	246	0		29	10	S5660_246_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	246	0		29	10	S5660_246_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	247	0		29	10	S5660_247_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	247	0		29	10	S5660_247_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	247	0		29	10	S5660_247_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	247	0		29	10	S5660_247_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	247	0		29	10	S5660_247_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	248	0		29	10	S5660_248_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	248	0		29	10	S5660_248_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	248	0		29	10	S5660_248_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	248	0		29	10	S5660_248_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	248	0		29	10	S5660_248_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	249	0		29	10	S5660_249_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	249	0		29	10	S5660_249_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	249	0		29	10	S5660_249_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	249	0		29	10	S5660_249_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	249	0		29	10	S5660_249_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	250	0		29	10	S5660_250_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	250	0		29	10	S5660_250_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	250	0		29	10	S5660_250_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	250	0		29	10	S5660_250_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	250	0		29	10	S5660_250_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5660	251	0		29	10	S5660_251_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5660	251	0		29	10	S5660_251_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5660	251	0		29	10	S5660_251_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5660	251	0		29	10	S5660_251_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5660	251	0		29	10	S5660_251_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	001	0		29	10	S5715_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	001	0		29	10	S5715_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5715	001	0		29	10	S5715_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	001	0		29	10	S5715_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	001	0		29	10	S5715_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	002	0		29	10	S5715_002_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	002	0		29	10	S5715_002_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5715	002	0		29	10	S5715_002_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	002	0		29	10	S5715_002_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	002	0		29	10	S5715_002_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	003	0		29	10	S5715_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	003	0		29	10	S5715_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5715	003	0		29	10	S5715_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	003	0		29	10	S5715_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	003	0		29	10	S5715_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	004	0		29	10	S5715_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	004	0		29	10	S5715_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5715	004	0		29	10	S5715_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	004	0		29	10	S5715_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	004	0		29	10	S5715_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	005	0		29	10	S5715_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	005	0		29	10	S5715_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5715	005	0		29	10	S5715_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	005	0		29	10	S5715_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	005	0		29	10	S5715_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	006	0		29	10	S5715_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	006	0		29	10	S5715_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5715	006	0		29	10	S5715_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	006	0		29	10	S5715_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	006	0		29	10	S5715_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	010	0		29	10	S5715_010_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	010	0		29	10	S5715_010_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5715	010	0		29	10	S5715_010_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	010	0		29	10	S5715_010_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	010	0		29	10	S5715_010_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	012	0		29	10	S5715_012_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	012	0		29	10	S5715_012_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5715	012	0		29	10	S5715_012_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	012	0		29	10	S5715_012_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	012	0		29	10	S5715_012_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	013	0		29	10	S5715_013_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	013	0		29	10	S5715_013_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5715	013	0		29	10	S5715_013_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	013	0		29	10	S5715_013_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	013	0		29	10	S5715_013_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	014	0		29	10	S5715_014_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	014	0		29	10	S5715_014_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5715	014	0		29	10	S5715_014_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	014	0		29	10	S5715_014_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	014	0		29	10	S5715_014_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	015	0		29	10	S5715_015_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	015	0		29	10	S5715_015_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5715	015	0		29	10	S5715_015_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	015	0		29	10	S5715_015_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	015	0		29	10	S5715_015_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5715	018	0		29	10	S5715_018_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5715	018	0		29	10	S5715_018_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5715	018	0		29	10	S5715_018_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5715	018	0		29	10	S5715_018_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5715	018	0		29	10	S5715_018_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5726	013	0		29	10	S5726_013_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5726	013	0		29	10	S5726_013_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5726	013	0		29	10	S5726_013_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5726	013	0		29	10	S5726_013_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5726	013	0		29	10	S5726_013_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5726	014	0		29	10	S5726_014_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5726	014	0		29	10	S5726_014_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5726	014	0		29	10	S5726_014_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5726	014	0		29	10	S5726_014_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5726	014	0		29	10	S5726_014_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5726	019	0		29	10	S5726_019_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5726	019	0		29	10	S5726_019_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5726	019	0		29	10	S5726_019_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5726	019	0		29	10	S5726_019_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5726	019	0		29	10	S5726_019_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5743	001	0		29	10	S5743_001_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5743	001	0		29	10	S5743_001_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5743	001	0		29	10	S5743_001_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5743	001	0		29	10	S5743_001_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5743	001	0		29	10	S5743_001_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5743	004	0		29	10	S5743_004_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5743	004	0		29	10	S5743_004_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5743	004	0		29	10	S5743_004_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5743	004	0		29	10	S5743_004_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5743	004	0		29	10	S5743_004_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5753	006	0		29	10	S5753_006_0	7	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5753	006	0		29	10	S5753_006_0	7	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5753	006	0		29	10	S5753_006_0	7	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5753	006	0		29	10	S5753_006_0	7	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5753	006	0		29	10	S5753_006_0	7	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5753	007	0		29	10	S5753_007_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5753	007	0		29	10	S5753_007_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5753	007	0		29	10	S5753_007_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5753	007	0		29	10	S5753_007_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5753	007	0		29	10	S5753_007_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	125	0		29	10	S5768_125_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	125	0		29	10	S5768_125_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	125	0		29	10	S5768_125_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	125	0		29	10	S5768_125_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	125	0		29	10	S5768_125_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	126	0		29	10	S5768_126_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	126	0		29	10	S5768_126_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	126	0		29	10	S5768_126_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	126	0		29	10	S5768_126_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	126	0		29	10	S5768_126_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	127	0		29	10	S5768_127_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	127	0		29	10	S5768_127_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	127	0		29	10	S5768_127_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	127	0		29	10	S5768_127_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	127	0		29	10	S5768_127_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	128	0		29	10	S5768_128_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	128	0		29	10	S5768_128_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	128	0		29	10	S5768_128_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	128	0		29	10	S5768_128_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	128	0		29	10	S5768_128_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	129	0		29	10	S5768_129_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	129	0		29	10	S5768_129_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	129	0		29	10	S5768_129_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	129	0		29	10	S5768_129_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	129	0		29	10	S5768_129_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	130	0		29	10	S5768_130_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	130	0		29	10	S5768_130_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	130	0		29	10	S5768_130_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	130	0		29	10	S5768_130_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	130	0		29	10	S5768_130_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	131	0		29	10	S5768_131_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	131	0		29	10	S5768_131_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	131	0		29	10	S5768_131_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	131	0		29	10	S5768_131_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	131	0		29	10	S5768_131_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	132	0		29	10	S5768_132_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	132	0		29	10	S5768_132_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	132	0		29	10	S5768_132_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	132	0		29	10	S5768_132_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	132	0		29	10	S5768_132_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	133	0		29	10	S5768_133_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	133	0		29	10	S5768_133_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	133	0		29	10	S5768_133_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	133	0		29	10	S5768_133_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	133	0		29	10	S5768_133_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	134	0		29	10	S5768_134_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	134	0		29	10	S5768_134_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	134	0		29	10	S5768_134_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	134	0		29	10	S5768_134_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	134	0		29	10	S5768_134_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	135	0		29	10	S5768_135_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	135	0		29	10	S5768_135_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	135	0		29	10	S5768_135_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	135	0		29	10	S5768_135_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	135	0		29	10	S5768_135_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	136	0		29	10	S5768_136_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	136	0		29	10	S5768_136_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	136	0		29	10	S5768_136_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	136	0		29	10	S5768_136_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	136	0		29	10	S5768_136_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	137	0		29	10	S5768_137_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	137	0		29	10	S5768_137_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	137	0		29	10	S5768_137_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	137	0		29	10	S5768_137_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	137	0		29	10	S5768_137_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	138	0		29	10	S5768_138_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	138	0		29	10	S5768_138_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	138	0		29	10	S5768_138_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	138	0		29	10	S5768_138_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	138	0		29	10	S5768_138_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	139	0		29	10	S5768_139_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	139	0		29	10	S5768_139_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	139	0		29	10	S5768_139_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	139	0		29	10	S5768_139_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	139	0		29	10	S5768_139_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	140	0		29	10	S5768_140_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	140	0		29	10	S5768_140_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	140	0		29	10	S5768_140_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	140	0		29	10	S5768_140_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	140	0		29	10	S5768_140_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	141	0		29	10	S5768_141_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	141	0		29	10	S5768_141_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	141	0		29	10	S5768_141_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	141	0		29	10	S5768_141_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	141	0		29	10	S5768_141_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	142	0		29	10	S5768_142_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	142	0		29	10	S5768_142_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	142	0		29	10	S5768_142_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	142	0		29	10	S5768_142_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	142	0		29	10	S5768_142_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	143	0		29	10	S5768_143_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	143	0		29	10	S5768_143_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	143	0		29	10	S5768_143_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	143	0		29	10	S5768_143_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	143	0		29	10	S5768_143_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	144	0		29	10	S5768_144_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	144	0		29	10	S5768_144_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	144	0		29	10	S5768_144_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	144	0		29	10	S5768_144_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	144	0		29	10	S5768_144_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	145	0		29	10	S5768_145_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	145	0		29	10	S5768_145_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	145	0		29	10	S5768_145_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	145	0		29	10	S5768_145_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	145	0		29	10	S5768_145_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	146	0		29	10	S5768_146_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	146	0		29	10	S5768_146_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	146	0		29	10	S5768_146_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	146	0		29	10	S5768_146_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	146	0		29	10	S5768_146_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	147	0		29	10	S5768_147_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	147	0		29	10	S5768_147_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	147	0		29	10	S5768_147_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	147	0		29	10	S5768_147_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	147	0		29	10	S5768_147_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	148	0		29	10	S5768_148_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	148	0		29	10	S5768_148_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	148	0		29	10	S5768_148_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	148	0		29	10	S5768_148_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	148	0		29	10	S5768_148_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	149	0		29	10	S5768_149_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	149	0		29	10	S5768_149_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	149	0		29	10	S5768_149_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	149	0		29	10	S5768_149_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	149	0		29	10	S5768_149_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	150	0		29	10	S5768_150_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	150	0		29	10	S5768_150_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	150	0		29	10	S5768_150_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	150	0		29	10	S5768_150_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	150	0		29	10	S5768_150_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	151	0		29	10	S5768_151_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	151	0		29	10	S5768_151_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	151	0		29	10	S5768_151_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	151	0		29	10	S5768_151_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	151	0		29	10	S5768_151_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	152	0		29	10	S5768_152_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	152	0		29	10	S5768_152_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	152	0		29	10	S5768_152_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	152	0		29	10	S5768_152_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	152	0		29	10	S5768_152_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	153	0		29	10	S5768_153_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	153	0		29	10	S5768_153_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	153	0		29	10	S5768_153_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	153	0		29	10	S5768_153_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	153	0		29	10	S5768_153_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	154	0		29	10	S5768_154_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	154	0		29	10	S5768_154_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	154	0		29	10	S5768_154_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	154	0		29	10	S5768_154_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	154	0		29	10	S5768_154_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	155	0		29	10	S5768_155_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	155	0		29	10	S5768_155_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	155	0		29	10	S5768_155_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	155	0		29	10	S5768_155_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	155	0		29	10	S5768_155_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	197	0		29	10	S5768_197_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	197	0		29	10	S5768_197_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	197	0		29	10	S5768_197_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	197	0		29	10	S5768_197_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	197	0		29	10	S5768_197_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	198	0		29	10	S5768_198_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	198	0		29	10	S5768_198_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	198	0		29	10	S5768_198_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	198	0		29	10	S5768_198_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	198	0		29	10	S5768_198_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5768	200	0		29	10	S5768_200_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5768	200	0		29	10	S5768_200_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5768	200	0		29	10	S5768_200_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5768	200	0		29	10	S5768_200_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5768	200	0		29	10	S5768_200_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5795	002	0		29	10	S5795_002_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5795	002	0		29	10	S5795_002_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5795	002	0		29	10	S5795_002_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5795	002	0		29	10	S5795_002_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5795	002	0		29	10	S5795_002_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5795	003	0		29	10	S5795_003_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5795	003	0		29	10	S5795_003_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5795	003	0		29	10	S5795_003_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5795	003	0		29	10	S5795_003_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5795	003	0		29	10	S5795_003_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5795	008	0		29	10	S5795_008_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5795	008	0		29	10	S5795_008_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5795	008	0		29	10	S5795_008_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5795	008	0		29	10	S5795_008_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5795	008	0		29	10	S5795_008_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5805	001	0		29	10	S5805_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5805	001	0		29	10	S5805_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5805	001	0		29	10	S5805_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5805	001	0		29	10	S5805_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5805	001	0		29	10	S5805_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	035	0		29	10	S5810_035_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	035	0		29	10	S5810_035_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	035	0		29	10	S5810_035_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	035	0		29	10	S5810_035_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	035	0		29	10	S5810_035_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	036	0		29	10	S5810_036_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	036	0		29	10	S5810_036_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	036	0		29	10	S5810_036_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	036	0		29	10	S5810_036_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	036	0		29	10	S5810_036_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	037	0		29	10	S5810_037_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	037	0		29	10	S5810_037_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	037	0		29	10	S5810_037_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	037	0		29	10	S5810_037_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	037	0		29	10	S5810_037_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	038	0		29	10	S5810_038_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	038	0		29	10	S5810_038_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	038	0		29	10	S5810_038_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	038	0		29	10	S5810_038_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	038	0		29	10	S5810_038_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	039	0		29	10	S5810_039_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	039	0		29	10	S5810_039_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	039	0		29	10	S5810_039_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	039	0		29	10	S5810_039_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	039	0		29	10	S5810_039_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	040	0		29	10	S5810_040_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	040	0		29	10	S5810_040_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	040	0		29	10	S5810_040_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	040	0		29	10	S5810_040_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	040	0		29	10	S5810_040_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	041	0		29	10	S5810_041_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	041	0		29	10	S5810_041_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	041	0		29	10	S5810_041_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	041	0		29	10	S5810_041_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	041	0		29	10	S5810_041_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	042	0		29	10	S5810_042_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	042	0		29	10	S5810_042_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	042	0		29	10	S5810_042_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	042	0		29	10	S5810_042_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	042	0		29	10	S5810_042_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	043	0		29	10	S5810_043_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	043	0		29	10	S5810_043_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	043	0		29	10	S5810_043_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	043	0		29	10	S5810_043_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	043	0		29	10	S5810_043_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	044	0		29	10	S5810_044_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	044	0		29	10	S5810_044_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	044	0		29	10	S5810_044_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	044	0		29	10	S5810_044_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	044	0		29	10	S5810_044_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	045	0		29	10	S5810_045_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	045	0		29	10	S5810_045_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	045	0		29	10	S5810_045_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	045	0		29	10	S5810_045_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	045	0		29	10	S5810_045_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	046	0		29	10	S5810_046_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	046	0		29	10	S5810_046_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	046	0		29	10	S5810_046_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	046	0		29	10	S5810_046_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	046	0		29	10	S5810_046_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	047	0		29	10	S5810_047_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	047	0		29	10	S5810_047_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	047	0		29	10	S5810_047_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	047	0		29	10	S5810_047_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	047	0		29	10	S5810_047_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	048	0		29	10	S5810_048_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	048	0		29	10	S5810_048_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	048	0		29	10	S5810_048_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	048	0		29	10	S5810_048_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	048	0		29	10	S5810_048_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	049	0		29	10	S5810_049_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	049	0		29	10	S5810_049_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	049	0		29	10	S5810_049_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	049	0		29	10	S5810_049_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	049	0		29	10	S5810_049_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	050	0		29	10	S5810_050_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	050	0		29	10	S5810_050_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	050	0		29	10	S5810_050_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	050	0		29	10	S5810_050_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	050	0		29	10	S5810_050_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	051	0		29	10	S5810_051_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	051	0		29	10	S5810_051_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	051	0		29	10	S5810_051_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	051	0		29	10	S5810_051_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	051	0		29	10	S5810_051_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	052	0		29	10	S5810_052_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	052	0		29	10	S5810_052_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	052	0		29	10	S5810_052_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	052	0		29	10	S5810_052_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	052	0		29	10	S5810_052_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	053	0		29	10	S5810_053_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	053	0		29	10	S5810_053_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	053	0		29	10	S5810_053_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	053	0		29	10	S5810_053_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	053	0		29	10	S5810_053_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	054	0		29	10	S5810_054_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	054	0		29	10	S5810_054_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	054	0		29	10	S5810_054_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	054	0		29	10	S5810_054_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	054	0		29	10	S5810_054_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	055	0		29	10	S5810_055_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	055	0		29	10	S5810_055_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	055	0		29	10	S5810_055_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	055	0		29	10	S5810_055_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	055	0		29	10	S5810_055_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	056	0		29	10	S5810_056_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	056	0		29	10	S5810_056_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	056	0		29	10	S5810_056_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	056	0		29	10	S5810_056_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	056	0		29	10	S5810_056_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	057	0		29	10	S5810_057_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	057	0		29	10	S5810_057_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	057	0		29	10	S5810_057_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	057	0		29	10	S5810_057_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	057	0		29	10	S5810_057_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	058	0		29	10	S5810_058_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	058	0		29	10	S5810_058_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	058	0		29	10	S5810_058_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	058	0		29	10	S5810_058_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	058	0		29	10	S5810_058_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	059	0		29	10	S5810_059_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	059	0		29	10	S5810_059_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	059	0		29	10	S5810_059_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	059	0		29	10	S5810_059_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	059	0		29	10	S5810_059_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	060	0		29	10	S5810_060_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	060	0		29	10	S5810_060_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	060	0		29	10	S5810_060_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	060	0		29	10	S5810_060_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	060	0		29	10	S5810_060_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	061	0		29	10	S5810_061_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	061	0		29	10	S5810_061_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	061	0		29	10	S5810_061_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	061	0		29	10	S5810_061_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	061	0		29	10	S5810_061_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	062	0		29	10	S5810_062_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	062	0		29	10	S5810_062_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	062	0		29	10	S5810_062_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	062	0		29	10	S5810_062_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	062	0		29	10	S5810_062_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	063	0		29	10	S5810_063_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	063	0		29	10	S5810_063_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	063	0		29	10	S5810_063_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	063	0		29	10	S5810_063_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	063	0		29	10	S5810_063_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	064	0		29	10	S5810_064_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	064	0		29	10	S5810_064_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	064	0		29	10	S5810_064_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	064	0		29	10	S5810_064_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	064	0		29	10	S5810_064_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	065	0		29	10	S5810_065_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	065	0		29	10	S5810_065_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	065	0		29	10	S5810_065_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	065	0		29	10	S5810_065_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	065	0		29	10	S5810_065_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	066	0		29	10	S5810_066_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	066	0		29	10	S5810_066_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	066	0		29	10	S5810_066_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	066	0		29	10	S5810_066_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	066	0		29	10	S5810_066_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	067	0		29	10	S5810_067_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	067	0		29	10	S5810_067_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	067	0		29	10	S5810_067_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	067	0		29	10	S5810_067_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	067	0		29	10	S5810_067_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	068	0		29	10	S5810_068_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	068	0		29	10	S5810_068_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	068	0		29	10	S5810_068_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	068	0		29	10	S5810_068_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	068	0		29	10	S5810_068_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	276	0		29	10	S5810_276_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	276	0		29	10	S5810_276_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	276	0		29	10	S5810_276_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	276	0		29	10	S5810_276_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	276	0		29	10	S5810_276_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	277	0		29	10	S5810_277_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	277	0		29	10	S5810_277_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	277	0		29	10	S5810_277_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	277	0		29	10	S5810_277_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	277	0		29	10	S5810_277_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	278	0		29	10	S5810_278_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	278	0		29	10	S5810_278_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	278	0		29	10	S5810_278_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	278	0		29	10	S5810_278_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	278	0		29	10	S5810_278_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	279	0		29	10	S5810_279_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	279	0		29	10	S5810_279_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	279	0		29	10	S5810_279_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	279	0		29	10	S5810_279_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	279	0		29	10	S5810_279_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	280	0		29	10	S5810_280_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	280	0		29	10	S5810_280_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	280	0		29	10	S5810_280_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	280	0		29	10	S5810_280_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	280	0		29	10	S5810_280_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	281	0		29	10	S5810_281_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	281	0		29	10	S5810_281_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	281	0		29	10	S5810_281_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	281	0		29	10	S5810_281_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	281	0		29	10	S5810_281_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	282	0		29	10	S5810_282_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	282	0		29	10	S5810_282_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	282	0		29	10	S5810_282_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	282	0		29	10	S5810_282_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	282	0		29	10	S5810_282_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	283	0		29	10	S5810_283_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	283	0		29	10	S5810_283_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	283	0		29	10	S5810_283_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	283	0		29	10	S5810_283_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	283	0		29	10	S5810_283_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	284	0		29	10	S5810_284_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	284	0		29	10	S5810_284_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	284	0		29	10	S5810_284_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	284	0		29	10	S5810_284_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	284	0		29	10	S5810_284_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	285	0		29	10	S5810_285_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	285	0		29	10	S5810_285_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	285	0		29	10	S5810_285_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	285	0		29	10	S5810_285_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	285	0		29	10	S5810_285_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	286	0		29	10	S5810_286_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	286	0		29	10	S5810_286_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	286	0		29	10	S5810_286_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	286	0		29	10	S5810_286_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	286	0		29	10	S5810_286_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	287	0		29	10	S5810_287_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	287	0		29	10	S5810_287_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	287	0		29	10	S5810_287_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	287	0		29	10	S5810_287_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	287	0		29	10	S5810_287_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	288	0		29	10	S5810_288_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	288	0		29	10	S5810_288_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	288	0		29	10	S5810_288_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	288	0		29	10	S5810_288_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	288	0		29	10	S5810_288_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	289	0		29	10	S5810_289_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	289	0		29	10	S5810_289_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	289	0		29	10	S5810_289_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	289	0		29	10	S5810_289_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	289	0		29	10	S5810_289_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	290	0		29	10	S5810_290_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	290	0		29	10	S5810_290_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	290	0		29	10	S5810_290_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	290	0		29	10	S5810_290_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	290	0		29	10	S5810_290_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	291	0		29	10	S5810_291_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	291	0		29	10	S5810_291_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	291	0		29	10	S5810_291_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	291	0		29	10	S5810_291_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	291	0		29	10	S5810_291_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	292	0		29	10	S5810_292_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	292	0		29	10	S5810_292_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	292	0		29	10	S5810_292_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	292	0		29	10	S5810_292_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	292	0		29	10	S5810_292_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	293	0		29	10	S5810_293_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	293	0		29	10	S5810_293_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	293	0		29	10	S5810_293_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	293	0		29	10	S5810_293_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	293	0		29	10	S5810_293_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	294	0		29	10	S5810_294_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	294	0		29	10	S5810_294_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	294	0		29	10	S5810_294_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	294	0		29	10	S5810_294_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	294	0		29	10	S5810_294_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	295	0		29	10	S5810_295_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	295	0		29	10	S5810_295_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	295	0		29	10	S5810_295_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	295	0		29	10	S5810_295_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	295	0		29	10	S5810_295_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	296	0		29	10	S5810_296_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	296	0		29	10	S5810_296_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	296	0		29	10	S5810_296_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	296	0		29	10	S5810_296_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	296	0		29	10	S5810_296_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	297	0		29	10	S5810_297_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	297	0		29	10	S5810_297_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	297	0		29	10	S5810_297_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	297	0		29	10	S5810_297_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	297	0		29	10	S5810_297_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	298	0		29	10	S5810_298_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	298	0		29	10	S5810_298_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	298	0		29	10	S5810_298_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	298	0		29	10	S5810_298_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	298	0		29	10	S5810_298_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	299	0		29	10	S5810_299_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	299	0		29	10	S5810_299_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	299	0		29	10	S5810_299_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	299	0		29	10	S5810_299_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	299	0		29	10	S5810_299_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	300	0		29	10	S5810_300_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	300	0		29	10	S5810_300_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	300	0		29	10	S5810_300_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	300	0		29	10	S5810_300_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	300	0		29	10	S5810_300_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	301	0		29	10	S5810_301_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	301	0		29	10	S5810_301_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	301	0		29	10	S5810_301_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	301	0		29	10	S5810_301_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	301	0		29	10	S5810_301_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	302	0		29	10	S5810_302_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	302	0		29	10	S5810_302_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	302	0		29	10	S5810_302_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	302	0		29	10	S5810_302_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	302	0		29	10	S5810_302_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	303	0		29	10	S5810_303_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	303	0		29	10	S5810_303_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	303	0		29	10	S5810_303_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	303	0		29	10	S5810_303_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	303	0		29	10	S5810_303_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	304	0		29	10	S5810_304_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	304	0		29	10	S5810_304_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	304	0		29	10	S5810_304_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	304	0		29	10	S5810_304_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	304	0		29	10	S5810_304_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	305	0		29	10	S5810_305_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	305	0		29	10	S5810_305_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	305	0		29	10	S5810_305_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	305	0		29	10	S5810_305_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	305	0		29	10	S5810_305_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	306	0		29	10	S5810_306_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	306	0		29	10	S5810_306_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	306	0		29	10	S5810_306_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	306	0		29	10	S5810_306_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	306	0		29	10	S5810_306_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	307	0		29	10	S5810_307_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	307	0		29	10	S5810_307_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	307	0		29	10	S5810_307_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	307	0		29	10	S5810_307_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	307	0		29	10	S5810_307_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	308	0		29	10	S5810_308_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	308	0		29	10	S5810_308_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	308	0		29	10	S5810_308_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	308	0		29	10	S5810_308_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	308	0		29	10	S5810_308_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5810	309	0		29	10	S5810_309_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5810	309	0		29	10	S5810_309_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5810	309	0		29	10	S5810_309_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5810	309	0		29	10	S5810_309_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5810	309	0		29	10	S5810_309_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	001	0		29	10	S5820_001_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	001	0		29	10	S5820_001_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	001	0		29	10	S5820_001_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	001	0		29	10	S5820_001_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	001	0		29	10	S5820_001_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	002	0		29	10	S5820_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	002	0		29	10	S5820_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	002	0		29	10	S5820_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	002	0		29	10	S5820_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	002	0		29	10	S5820_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	003	0		29	10	S5820_003_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	003	0		29	10	S5820_003_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	003	0		29	10	S5820_003_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	003	0		29	10	S5820_003_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	003	0		29	10	S5820_003_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	004	0		29	10	S5820_004_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	004	0		29	10	S5820_004_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	004	0		29	10	S5820_004_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	004	0		29	10	S5820_004_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	004	0		29	10	S5820_004_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	005	0		29	10	S5820_005_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	005	0		29	10	S5820_005_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	005	0		29	10	S5820_005_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	005	0		29	10	S5820_005_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	005	0		29	10	S5820_005_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	006	0		29	10	S5820_006_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	006	0		29	10	S5820_006_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	006	0		29	10	S5820_006_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	006	0		29	10	S5820_006_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	006	0		29	10	S5820_006_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	007	0		29	10	S5820_007_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	007	0		29	10	S5820_007_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	007	0		29	10	S5820_007_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	007	0		29	10	S5820_007_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	007	0		29	10	S5820_007_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	008	0		29	10	S5820_008_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	008	0		29	10	S5820_008_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	008	0		29	10	S5820_008_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	008	0		29	10	S5820_008_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	008	0		29	10	S5820_008_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	009	0		29	10	S5820_009_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	009	0		29	10	S5820_009_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	009	0		29	10	S5820_009_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	009	0		29	10	S5820_009_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	009	0		29	10	S5820_009_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	010	0		29	10	S5820_010_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	010	0		29	10	S5820_010_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	010	0		29	10	S5820_010_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	010	0		29	10	S5820_010_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	010	0		29	10	S5820_010_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	011	0		29	10	S5820_011_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	011	0		29	10	S5820_011_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	011	0		29	10	S5820_011_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	011	0		29	10	S5820_011_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	011	0		29	10	S5820_011_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	012	0		29	10	S5820_012_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	012	0		29	10	S5820_012_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	012	0		29	10	S5820_012_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	012	0		29	10	S5820_012_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	012	0		29	10	S5820_012_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	013	0		29	10	S5820_013_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	013	0		29	10	S5820_013_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	013	0		29	10	S5820_013_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	013	0		29	10	S5820_013_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	013	0		29	10	S5820_013_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	014	0		29	10	S5820_014_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	014	0		29	10	S5820_014_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	014	0		29	10	S5820_014_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	014	0		29	10	S5820_014_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	014	0		29	10	S5820_014_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	015	0		29	10	S5820_015_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	015	0		29	10	S5820_015_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	015	0		29	10	S5820_015_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	015	0		29	10	S5820_015_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	015	0		29	10	S5820_015_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	016	0		29	10	S5820_016_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	016	0		29	10	S5820_016_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	016	0		29	10	S5820_016_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	016	0		29	10	S5820_016_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	016	0		29	10	S5820_016_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	017	0		29	10	S5820_017_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	017	0		29	10	S5820_017_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	017	0		29	10	S5820_017_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	017	0		29	10	S5820_017_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	017	0		29	10	S5820_017_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	018	0		29	10	S5820_018_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	018	0		29	10	S5820_018_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	018	0		29	10	S5820_018_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	018	0		29	10	S5820_018_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	018	0		29	10	S5820_018_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	019	0		29	10	S5820_019_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	019	0		29	10	S5820_019_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	019	0		29	10	S5820_019_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	019	0		29	10	S5820_019_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	019	0		29	10	S5820_019_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	020	0		29	10	S5820_020_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	020	0		29	10	S5820_020_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	020	0		29	10	S5820_020_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	020	0		29	10	S5820_020_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	020	0		29	10	S5820_020_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	021	0		29	10	S5820_021_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	021	0		29	10	S5820_021_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	021	0		29	10	S5820_021_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	021	0		29	10	S5820_021_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	021	0		29	10	S5820_021_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	022	0		29	10	S5820_022_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	022	0		29	10	S5820_022_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	022	0		29	10	S5820_022_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	022	0		29	10	S5820_022_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	022	0		29	10	S5820_022_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	023	0		29	10	S5820_023_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	023	0		29	10	S5820_023_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	023	0		29	10	S5820_023_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	023	0		29	10	S5820_023_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	023	0		29	10	S5820_023_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	024	0		29	10	S5820_024_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	024	0		29	10	S5820_024_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	024	0		29	10	S5820_024_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	024	0		29	10	S5820_024_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	024	0		29	10	S5820_024_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	025	0		29	10	S5820_025_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	025	0		29	10	S5820_025_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	025	0		29	10	S5820_025_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	025	0		29	10	S5820_025_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	025	0		29	10	S5820_025_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	026	0		29	10	S5820_026_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	026	0		29	10	S5820_026_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	026	0		29	10	S5820_026_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	026	0		29	10	S5820_026_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	026	0		29	10	S5820_026_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	027	0		29	10	S5820_027_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	027	0		29	10	S5820_027_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	027	0		29	10	S5820_027_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	027	0		29	10	S5820_027_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	027	0		29	10	S5820_027_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	028	0		29	10	S5820_028_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	028	0		29	10	S5820_028_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	028	0		29	10	S5820_028_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	028	0		29	10	S5820_028_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	028	0		29	10	S5820_028_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	029	0		29	10	S5820_029_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	029	0		29	10	S5820_029_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	029	0		29	10	S5820_029_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	029	0		29	10	S5820_029_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	029	0		29	10	S5820_029_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	030	0		29	10	S5820_030_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	030	0		29	10	S5820_030_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	030	0		29	10	S5820_030_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	030	0		29	10	S5820_030_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	030	0		29	10	S5820_030_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	031	0		29	10	S5820_031_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	031	0		29	10	S5820_031_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	031	0		29	10	S5820_031_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	031	0		29	10	S5820_031_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	031	0		29	10	S5820_031_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	032	0		29	10	S5820_032_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	032	0		29	10	S5820_032_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	032	0		29	10	S5820_032_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	032	0		29	10	S5820_032_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	032	0		29	10	S5820_032_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	033	0		29	10	S5820_033_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	033	0		29	10	S5820_033_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5820	033	0		29	10	S5820_033_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	033	0		29	10	S5820_033_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	033	0		29	10	S5820_033_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	034	0		29	10	S5820_034_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	034	0		29	10	S5820_034_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5820	034	0		29	10	S5820_034_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	034	0		29	10	S5820_034_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	034	0		29	10	S5820_034_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	035	0		29	10	S5820_035_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	035	0		29	10	S5820_035_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5820	035	0		29	10	S5820_035_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	035	0		29	10	S5820_035_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	035	0		29	10	S5820_035_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	036	0		29	10	S5820_036_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	036	0		29	10	S5820_036_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5820	036	0		29	10	S5820_036_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	036	0		29	10	S5820_036_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	036	0		29	10	S5820_036_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	037	0		29	10	S5820_037_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	037	0		29	10	S5820_037_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5820	037	0		29	10	S5820_037_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	037	0		29	10	S5820_037_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	037	0		29	10	S5820_037_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5820	038	0		29	10	S5820_038_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5820	038	0		29	10	S5820_038_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5820	038	0		29	10	S5820_038_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5820	038	0		29	10	S5820_038_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5820	038	0		29	10	S5820_038_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	101	0		29	10	S5884_101_0	5	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	101	0		29	10	S5884_101_0	5	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	101	0		29	10	S5884_101_0	5	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	101	0		29	10	S5884_101_0	5	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	101	0		29	10	S5884_101_0	5	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	102	0		29	10	S5884_102_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	102	0		29	10	S5884_102_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	102	0		29	10	S5884_102_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	102	0		29	10	S5884_102_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	102	0		29	10	S5884_102_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	103	0		29	10	S5884_103_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	103	0		29	10	S5884_103_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	103	0		29	10	S5884_103_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	103	0		29	10	S5884_103_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	103	0		29	10	S5884_103_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	104	0		29	10	S5884_104_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	104	0		29	10	S5884_104_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	104	0		29	10	S5884_104_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	104	0		29	10	S5884_104_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	104	0		29	10	S5884_104_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	105	0		29	10	S5884_105_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	105	0		29	10	S5884_105_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	105	0		29	10	S5884_105_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	105	0		29	10	S5884_105_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	105	0		29	10	S5884_105_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	106	0		29	10	S5884_106_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	106	0		29	10	S5884_106_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	106	0		29	10	S5884_106_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	106	0		29	10	S5884_106_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	106	0		29	10	S5884_106_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	107	0		29	10	S5884_107_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	107	0		29	10	S5884_107_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	107	0		29	10	S5884_107_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	107	0		29	10	S5884_107_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	107	0		29	10	S5884_107_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	108	0		29	10	S5884_108_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	108	0		29	10	S5884_108_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	108	0		29	10	S5884_108_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	108	0		29	10	S5884_108_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	108	0		29	10	S5884_108_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	109	0		29	10	S5884_109_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	109	0		29	10	S5884_109_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	109	0		29	10	S5884_109_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	109	0		29	10	S5884_109_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	109	0		29	10	S5884_109_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	110	0		29	10	S5884_110_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	110	0		29	10	S5884_110_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	110	0		29	10	S5884_110_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	110	0		29	10	S5884_110_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	110	0		29	10	S5884_110_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	111	0		29	10	S5884_111_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	111	0		29	10	S5884_111_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	111	0		29	10	S5884_111_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	111	0		29	10	S5884_111_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	111	0		29	10	S5884_111_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	112	0		29	10	S5884_112_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	112	0		29	10	S5884_112_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	112	0		29	10	S5884_112_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	112	0		29	10	S5884_112_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	112	0		29	10	S5884_112_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	113	0		29	10	S5884_113_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	113	0		29	10	S5884_113_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	113	0		29	10	S5884_113_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	113	0		29	10	S5884_113_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	113	0		29	10	S5884_113_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	114	0		29	10	S5884_114_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	114	0		29	10	S5884_114_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	114	0		29	10	S5884_114_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	114	0		29	10	S5884_114_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	114	0		29	10	S5884_114_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	115	0		29	10	S5884_115_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	115	0		29	10	S5884_115_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	115	0		29	10	S5884_115_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	115	0		29	10	S5884_115_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	115	0		29	10	S5884_115_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	116	0		29	10	S5884_116_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	116	0		29	10	S5884_116_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	116	0		29	10	S5884_116_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	116	0		29	10	S5884_116_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	116	0		29	10	S5884_116_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	131	0		29	10	S5884_131_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	131	0		29	10	S5884_131_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	131	0		29	10	S5884_131_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	131	0		29	10	S5884_131_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	131	0		29	10	S5884_131_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	132	0		29	10	S5884_132_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	132	0		29	10	S5884_132_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	132	0		29	10	S5884_132_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	132	0		29	10	S5884_132_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	132	0		29	10	S5884_132_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	133	0		29	10	S5884_133_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	133	0		29	10	S5884_133_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	133	0		29	10	S5884_133_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	133	0		29	10	S5884_133_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	133	0		29	10	S5884_133_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	134	0		29	10	S5884_134_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	134	0		29	10	S5884_134_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	134	0		29	10	S5884_134_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	134	0		29	10	S5884_134_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	134	0		29	10	S5884_134_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	135	0		29	10	S5884_135_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	135	0		29	10	S5884_135_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	135	0		29	10	S5884_135_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	135	0		29	10	S5884_135_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	135	0		29	10	S5884_135_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	136	0		29	10	S5884_136_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	136	0		29	10	S5884_136_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	136	0		29	10	S5884_136_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	136	0		29	10	S5884_136_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	136	0		29	10	S5884_136_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	137	0		29	10	S5884_137_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	137	0		29	10	S5884_137_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	137	0		29	10	S5884_137_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	137	0		29	10	S5884_137_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	137	0		29	10	S5884_137_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	138	0		29	10	S5884_138_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	138	0		29	10	S5884_138_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	138	0		29	10	S5884_138_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	138	0		29	10	S5884_138_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	138	0		29	10	S5884_138_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	139	0		29	10	S5884_139_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	139	0		29	10	S5884_139_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	139	0		29	10	S5884_139_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	139	0		29	10	S5884_139_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	139	0		29	10	S5884_139_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	140	0		29	10	S5884_140_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	140	0		29	10	S5884_140_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	140	0		29	10	S5884_140_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	140	0		29	10	S5884_140_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	140	0		29	10	S5884_140_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	141	0		29	10	S5884_141_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	141	0		29	10	S5884_141_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	141	0		29	10	S5884_141_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	141	0		29	10	S5884_141_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	141	0		29	10	S5884_141_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	142	0		29	10	S5884_142_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	142	0		29	10	S5884_142_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	142	0		29	10	S5884_142_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	142	0		29	10	S5884_142_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	142	0		29	10	S5884_142_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	143	0		29	10	S5884_143_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	143	0		29	10	S5884_143_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	143	0		29	10	S5884_143_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	143	0		29	10	S5884_143_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	143	0		29	10	S5884_143_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	144	0		29	10	S5884_144_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	144	0		29	10	S5884_144_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	144	0		29	10	S5884_144_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	144	0		29	10	S5884_144_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	144	0		29	10	S5884_144_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	145	0		29	10	S5884_145_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	145	0		29	10	S5884_145_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	145	0		29	10	S5884_145_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	145	0		29	10	S5884_145_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	145	0		29	10	S5884_145_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	146	0		29	10	S5884_146_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	146	0		29	10	S5884_146_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	146	0		29	10	S5884_146_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	146	0		29	10	S5884_146_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	146	0		29	10	S5884_146_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	147	0		29	10	S5884_147_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	147	0		29	10	S5884_147_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	147	0		29	10	S5884_147_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	147	0		29	10	S5884_147_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	147	0		29	10	S5884_147_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	148	0		29	10	S5884_148_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	148	0		29	10	S5884_148_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	148	0		29	10	S5884_148_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	148	0		29	10	S5884_148_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	148	0		29	10	S5884_148_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	149	0		29	10	S5884_149_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	149	0		29	10	S5884_149_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	149	0		29	10	S5884_149_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	149	0		29	10	S5884_149_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	149	0		29	10	S5884_149_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	150	0		29	10	S5884_150_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	150	0		29	10	S5884_150_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	150	0		29	10	S5884_150_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	150	0		29	10	S5884_150_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	150	0		29	10	S5884_150_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	151	0		29	10	S5884_151_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	151	0		29	10	S5884_151_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	151	0		29	10	S5884_151_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	151	0		29	10	S5884_151_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	151	0		29	10	S5884_151_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	152	0		29	10	S5884_152_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	152	0		29	10	S5884_152_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	152	0		29	10	S5884_152_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	152	0		29	10	S5884_152_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	152	0		29	10	S5884_152_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	153	0		29	10	S5884_153_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	153	0		29	10	S5884_153_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	153	0		29	10	S5884_153_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	153	0		29	10	S5884_153_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	153	0		29	10	S5884_153_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	154	0		29	10	S5884_154_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	154	0		29	10	S5884_154_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	154	0		29	10	S5884_154_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	154	0		29	10	S5884_154_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	154	0		29	10	S5884_154_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	155	0		29	10	S5884_155_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	155	0		29	10	S5884_155_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	155	0		29	10	S5884_155_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	155	0		29	10	S5884_155_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	155	0		29	10	S5884_155_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	156	0		29	10	S5884_156_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	156	0		29	10	S5884_156_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	156	0		29	10	S5884_156_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	156	0		29	10	S5884_156_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	156	0		29	10	S5884_156_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	157	0		29	10	S5884_157_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	157	0		29	10	S5884_157_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	157	0		29	10	S5884_157_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	157	0		29	10	S5884_157_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	157	0		29	10	S5884_157_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	158	0		29	10	S5884_158_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	158	0		29	10	S5884_158_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	158	0		29	10	S5884_158_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	158	0		29	10	S5884_158_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	158	0		29	10	S5884_158_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	159	0		29	10	S5884_159_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	159	0		29	10	S5884_159_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	159	0		29	10	S5884_159_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	159	0		29	10	S5884_159_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	159	0		29	10	S5884_159_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	160	0		29	10	S5884_160_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	160	0		29	10	S5884_160_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	160	0		29	10	S5884_160_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	160	0		29	10	S5884_160_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	160	0		29	10	S5884_160_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	161	0		29	10	S5884_161_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	161	0		29	10	S5884_161_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	161	0		29	10	S5884_161_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	161	0		29	10	S5884_161_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	161	0		29	10	S5884_161_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	162	0		29	10	S5884_162_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	162	0		29	10	S5884_162_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	162	0		29	10	S5884_162_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	162	0		29	10	S5884_162_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	162	0		29	10	S5884_162_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	163	0		29	10	S5884_163_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	163	0		29	10	S5884_163_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	163	0		29	10	S5884_163_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	163	0		29	10	S5884_163_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	163	0		29	10	S5884_163_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	164	0		29	10	S5884_164_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	164	0		29	10	S5884_164_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	164	0		29	10	S5884_164_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	164	0		29	10	S5884_164_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	164	0		29	10	S5884_164_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	165	0		29	10	S5884_165_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	165	0		29	10	S5884_165_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	165	0		29	10	S5884_165_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	165	0		29	10	S5884_165_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	165	0		29	10	S5884_165_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	166	0		29	10	S5884_166_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	166	0		29	10	S5884_166_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	166	0		29	10	S5884_166_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	166	0		29	10	S5884_166_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	166	0		29	10	S5884_166_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	167	0		29	10	S5884_167_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	167	0		29	10	S5884_167_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	167	0		29	10	S5884_167_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	167	0		29	10	S5884_167_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	167	0		29	10	S5884_167_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	168	0		29	10	S5884_168_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	168	0		29	10	S5884_168_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	168	0		29	10	S5884_168_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	168	0		29	10	S5884_168_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	168	0		29	10	S5884_168_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	169	0		29	10	S5884_169_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	169	0		29	10	S5884_169_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	169	0		29	10	S5884_169_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	169	0		29	10	S5884_169_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	169	0		29	10	S5884_169_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	170	0		29	10	S5884_170_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	170	0		29	10	S5884_170_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	170	0		29	10	S5884_170_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	170	0		29	10	S5884_170_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	170	0		29	10	S5884_170_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	171	0		29	10	S5884_171_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	171	0		29	10	S5884_171_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	171	0		29	10	S5884_171_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	171	0		29	10	S5884_171_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	171	0		29	10	S5884_171_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	172	0		29	10	S5884_172_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	172	0		29	10	S5884_172_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	172	0		29	10	S5884_172_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	172	0		29	10	S5884_172_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	172	0		29	10	S5884_172_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	173	0		29	10	S5884_173_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	173	0		29	10	S5884_173_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	173	0		29	10	S5884_173_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	173	0		29	10	S5884_173_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	173	0		29	10	S5884_173_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	174	0		29	10	S5884_174_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	174	0		29	10	S5884_174_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	174	0		29	10	S5884_174_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	174	0		29	10	S5884_174_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	174	0		29	10	S5884_174_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	175	0		29	10	S5884_175_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	175	0		29	10	S5884_175_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	175	0		29	10	S5884_175_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	175	0		29	10	S5884_175_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	175	0		29	10	S5884_175_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	176	0		29	10	S5884_176_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	176	0		29	10	S5884_176_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	176	0		29	10	S5884_176_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	176	0		29	10	S5884_176_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	176	0		29	10	S5884_176_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	177	0		29	10	S5884_177_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	177	0		29	10	S5884_177_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	177	0		29	10	S5884_177_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	177	0		29	10	S5884_177_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	177	0		29	10	S5884_177_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	178	0		29	10	S5884_178_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	178	0		29	10	S5884_178_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	178	0		29	10	S5884_178_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	178	0		29	10	S5884_178_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	178	0		29	10	S5884_178_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	179	0		29	10	S5884_179_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	179	0		29	10	S5884_179_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	179	0		29	10	S5884_179_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	179	0		29	10	S5884_179_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	179	0		29	10	S5884_179_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	180	0		29	10	S5884_180_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	180	0		29	10	S5884_180_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	3						
S5884	180	0		29	10	S5884_180_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	180	0		29	10	S5884_180_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	180	0		29	10	S5884_180_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	181	0		29	10	S5884_181_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	181	0		29	10	S5884_181_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	181	0		29	10	S5884_181_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	181	0		29	10	S5884_181_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	181	0		29	10	S5884_181_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	182	0		29	10	S5884_182_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	182	0		29	10	S5884_182_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	182	0		29	10	S5884_182_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	182	0		29	10	S5884_182_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	182	0		29	10	S5884_182_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	183	0		29	10	S5884_183_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	183	0		29	10	S5884_183_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	183	0		29	10	S5884_183_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	183	0		29	10	S5884_183_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	183	0		29	10	S5884_183_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	184	0		29	10	S5884_184_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	184	0		29	10	S5884_184_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	184	0		29	10	S5884_184_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	184	0		29	10	S5884_184_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	184	0		29	10	S5884_184_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	185	0		29	10	S5884_185_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	185	0		29	10	S5884_185_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	185	0		29	10	S5884_185_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	185	0		29	10	S5884_185_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	185	0		29	10	S5884_185_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	186	0		29	10	S5884_186_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	186	0		29	10	S5884_186_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	186	0		29	10	S5884_186_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	186	0		29	10	S5884_186_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	186	0		29	10	S5884_186_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	187	0		29	10	S5884_187_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	187	0		29	10	S5884_187_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	187	0		29	10	S5884_187_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	187	0		29	10	S5884_187_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	187	0		29	10	S5884_187_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	188	0		29	10	S5884_188_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	188	0		29	10	S5884_188_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	188	0		29	10	S5884_188_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	188	0		29	10	S5884_188_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	188	0		29	10	S5884_188_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	189	0		29	10	S5884_189_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	189	0		29	10	S5884_189_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	189	0		29	10	S5884_189_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	189	0		29	10	S5884_189_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	189	0		29	10	S5884_189_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	190	0		29	10	S5884_190_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	190	0		29	10	S5884_190_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	190	0		29	10	S5884_190_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	190	0		29	10	S5884_190_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	190	0		29	10	S5884_190_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	191	0		29	10	S5884_191_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	191	0		29	10	S5884_191_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	191	0		29	10	S5884_191_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	191	0		29	10	S5884_191_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	191	0		29	10	S5884_191_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	192	0		29	10	S5884_192_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	192	0		29	10	S5884_192_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	192	0		29	10	S5884_192_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	192	0		29	10	S5884_192_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	192	0		29	10	S5884_192_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	193	0		29	10	S5884_193_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	193	0		29	10	S5884_193_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	193	0		29	10	S5884_193_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	193	0		29	10	S5884_193_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	193	0		29	10	S5884_193_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	194	0		29	10	S5884_194_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	194	0		29	10	S5884_194_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	194	0		29	10	S5884_194_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	194	0		29	10	S5884_194_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	194	0		29	10	S5884_194_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	195	0		29	10	S5884_195_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	195	0		29	10	S5884_195_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	195	0		29	10	S5884_195_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	195	0		29	10	S5884_195_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	195	0		29	10	S5884_195_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	196	0		29	10	S5884_196_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	196	0		29	10	S5884_196_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	196	0		29	10	S5884_196_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	196	0		29	10	S5884_196_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	196	0		29	10	S5884_196_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	197	0		29	10	S5884_197_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	197	0		29	10	S5884_197_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	197	0		29	10	S5884_197_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	197	0		29	10	S5884_197_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	197	0		29	10	S5884_197_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	198	0		29	10	S5884_198_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	198	0		29	10	S5884_198_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	198	0		29	10	S5884_198_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	198	0		29	10	S5884_198_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	198	0		29	10	S5884_198_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	199	0		29	10	S5884_199_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	199	0		29	10	S5884_199_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	199	0		29	10	S5884_199_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	199	0		29	10	S5884_199_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	199	0		29	10	S5884_199_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	200	0		29	10	S5884_200_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	200	0		29	10	S5884_200_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	200	0		29	10	S5884_200_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	200	0		29	10	S5884_200_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	200	0		29	10	S5884_200_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	201	0		29	10	S5884_201_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	201	0		29	10	S5884_201_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	201	0		29	10	S5884_201_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	201	0		29	10	S5884_201_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	201	0		29	10	S5884_201_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	202	0		29	10	S5884_202_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	202	0		29	10	S5884_202_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	202	0		29	10	S5884_202_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	202	0		29	10	S5884_202_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	202	0		29	10	S5884_202_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	203	0		29	10	S5884_203_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	203	0		29	10	S5884_203_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	203	0		29	10	S5884_203_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	203	0		29	10	S5884_203_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	203	0		29	10	S5884_203_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	204	0		29	10	S5884_204_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	204	0		29	10	S5884_204_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	204	0		29	10	S5884_204_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	204	0		29	10	S5884_204_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	204	0		29	10	S5884_204_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	205	0		29	10	S5884_205_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	205	0		29	10	S5884_205_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	205	0		29	10	S5884_205_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	205	0		29	10	S5884_205_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	205	0		29	10	S5884_205_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	206	0		29	10	S5884_206_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	206	0		29	10	S5884_206_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	206	0		29	10	S5884_206_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	206	0		29	10	S5884_206_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	206	0		29	10	S5884_206_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	207	0		29	10	S5884_207_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	207	0		29	10	S5884_207_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	207	0		29	10	S5884_207_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	207	0		29	10	S5884_207_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	207	0		29	10	S5884_207_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	208	0		29	10	S5884_208_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	208	0		29	10	S5884_208_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	208	0		29	10	S5884_208_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	208	0		29	10	S5884_208_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	208	0		29	10	S5884_208_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	209	0		29	10	S5884_209_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	209	0		29	10	S5884_209_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	209	0		29	10	S5884_209_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	209	0		29	10	S5884_209_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	209	0		29	10	S5884_209_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	210	0		29	10	S5884_210_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	210	0		29	10	S5884_210_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	210	0		29	10	S5884_210_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	210	0		29	10	S5884_210_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	210	0		29	10	S5884_210_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	211	0		29	10	S5884_211_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	211	0		29	10	S5884_211_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	211	0		29	10	S5884_211_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	211	0		29	10	S5884_211_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	211	0		29	10	S5884_211_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	212	0		29	10	S5884_212_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	212	0		29	10	S5884_212_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	212	0		29	10	S5884_212_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	212	0		29	10	S5884_212_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	212	0		29	10	S5884_212_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5884	213	0		29	10	S5884_213_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	11	1						
S5884	213	0		29	10	S5884_213_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	11	1						
S5884	213	0		29	10	S5884_213_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5884	213	0		29	10	S5884_213_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5884	213	0		29	10	S5884_213_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5904	001	0		29	10	S5904_001_0	7	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5904	001	0		29	10	S5904_001_0	7	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5904	001	0		29	10	S5904_001_0	7	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5904	001	0		29	10	S5904_001_0	7	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5904	001	0		29	10	S5904_001_0	7	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5904	002	0		29	10	S5904_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5904	002	0		29	10	S5904_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5904	002	0		29	10	S5904_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5904	002	0		29	10	S5904_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5904	002	0		29	10	S5904_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5916	001	0		29	10	S5916_001_0	4	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5916	001	0		29	10	S5916_001_0	4	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5916	001	0		29	10	S5916_001_0	4	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5916	001	0		29	10	S5916_001_0	4	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5916	001	0		29	10	S5916_001_0	4	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5916	002	0		29	10	S5916_002_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5916	002	0		29	10	S5916_002_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5916	002	0		29	10	S5916_002_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5916	002	0		29	10	S5916_002_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5916	002	0		29	10	S5916_002_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	348	0		29	10	S5921_348_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	348	0		29	10	S5921_348_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	348	0		29	10	S5921_348_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	348	0		29	10	S5921_348_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	348	0		29	10	S5921_348_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	349	0		29	10	S5921_349_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	349	0		29	10	S5921_349_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	349	0		29	10	S5921_349_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	349	0		29	10	S5921_349_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	349	0		29	10	S5921_349_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	350	0		29	10	S5921_350_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	350	0		29	10	S5921_350_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	350	0		29	10	S5921_350_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	350	0		29	10	S5921_350_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	350	0		29	10	S5921_350_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	351	0		29	10	S5921_351_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	351	0		29	10	S5921_351_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	351	0		29	10	S5921_351_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	351	0		29	10	S5921_351_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	351	0		29	10	S5921_351_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	352	0		29	10	S5921_352_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	352	0		29	10	S5921_352_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	352	0		29	10	S5921_352_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	352	0		29	10	S5921_352_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	352	0		29	10	S5921_352_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	353	0		29	10	S5921_353_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	353	0		29	10	S5921_353_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	353	0		29	10	S5921_353_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	353	0		29	10	S5921_353_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	353	0		29	10	S5921_353_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	354	0		29	10	S5921_354_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	354	0		29	10	S5921_354_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	354	0		29	10	S5921_354_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	354	0		29	10	S5921_354_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	354	0		29	10	S5921_354_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	355	0		29	10	S5921_355_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	355	0		29	10	S5921_355_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	355	0		29	10	S5921_355_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	355	0		29	10	S5921_355_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	355	0		29	10	S5921_355_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	356	0		29	10	S5921_356_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	356	0		29	10	S5921_356_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	356	0		29	10	S5921_356_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	356	0		29	10	S5921_356_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	356	0		29	10	S5921_356_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	357	0		29	10	S5921_357_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	357	0		29	10	S5921_357_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	357	0		29	10	S5921_357_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	357	0		29	10	S5921_357_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	357	0		29	10	S5921_357_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	358	0		29	10	S5921_358_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	358	0		29	10	S5921_358_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	358	0		29	10	S5921_358_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	358	0		29	10	S5921_358_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	358	0		29	10	S5921_358_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	359	0		29	10	S5921_359_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	359	0		29	10	S5921_359_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	359	0		29	10	S5921_359_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	359	0		29	10	S5921_359_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	359	0		29	10	S5921_359_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	360	0		29	10	S5921_360_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	360	0		29	10	S5921_360_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	360	0		29	10	S5921_360_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	360	0		29	10	S5921_360_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	360	0		29	10	S5921_360_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	361	0		29	10	S5921_361_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	361	0		29	10	S5921_361_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	361	0		29	10	S5921_361_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	361	0		29	10	S5921_361_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	361	0		29	10	S5921_361_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	362	0		29	10	S5921_362_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	362	0		29	10	S5921_362_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	362	0		29	10	S5921_362_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	362	0		29	10	S5921_362_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	362	0		29	10	S5921_362_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	363	0		29	10	S5921_363_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	363	0		29	10	S5921_363_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	363	0		29	10	S5921_363_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	363	0		29	10	S5921_363_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	363	0		29	10	S5921_363_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	364	0		29	10	S5921_364_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	364	0		29	10	S5921_364_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	364	0		29	10	S5921_364_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	364	0		29	10	S5921_364_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	364	0		29	10	S5921_364_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	365	0		29	10	S5921_365_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	365	0		29	10	S5921_365_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	365	0		29	10	S5921_365_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	365	0		29	10	S5921_365_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	365	0		29	10	S5921_365_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	366	0		29	10	S5921_366_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	366	0		29	10	S5921_366_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	366	0		29	10	S5921_366_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	366	0		29	10	S5921_366_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	366	0		29	10	S5921_366_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	367	0		29	10	S5921_367_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	367	0		29	10	S5921_367_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	367	0		29	10	S5921_367_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	367	0		29	10	S5921_367_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	367	0		29	10	S5921_367_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	368	0		29	10	S5921_368_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	368	0		29	10	S5921_368_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	368	0		29	10	S5921_368_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	368	0		29	10	S5921_368_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	368	0		29	10	S5921_368_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	369	0		29	10	S5921_369_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	369	0		29	10	S5921_369_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	369	0		29	10	S5921_369_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	369	0		29	10	S5921_369_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	369	0		29	10	S5921_369_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	370	0		29	10	S5921_370_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	370	0		29	10	S5921_370_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	370	0		29	10	S5921_370_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	370	0		29	10	S5921_370_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	370	0		29	10	S5921_370_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	371	0		29	10	S5921_371_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	371	0		29	10	S5921_371_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	371	0		29	10	S5921_371_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	371	0		29	10	S5921_371_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	371	0		29	10	S5921_371_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	372	0		29	10	S5921_372_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	372	0		29	10	S5921_372_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	372	0		29	10	S5921_372_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	372	0		29	10	S5921_372_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	372	0		29	10	S5921_372_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	373	0		29	10	S5921_373_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	373	0		29	10	S5921_373_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	373	0		29	10	S5921_373_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	373	0		29	10	S5921_373_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	373	0		29	10	S5921_373_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	374	0		29	10	S5921_374_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	374	0		29	10	S5921_374_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	374	0		29	10	S5921_374_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	374	0		29	10	S5921_374_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	374	0		29	10	S5921_374_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	375	0		29	10	S5921_375_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	375	0		29	10	S5921_375_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	375	0		29	10	S5921_375_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	375	0		29	10	S5921_375_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	375	0		29	10	S5921_375_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	376	0		29	10	S5921_376_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	376	0		29	10	S5921_376_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	376	0		29	10	S5921_376_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	376	0		29	10	S5921_376_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	376	0		29	10	S5921_376_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	377	0		29	10	S5921_377_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	377	0		29	10	S5921_377_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	377	0		29	10	S5921_377_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	377	0		29	10	S5921_377_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	377	0		29	10	S5921_377_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	378	0		29	10	S5921_378_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	378	0		29	10	S5921_378_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	378	0		29	10	S5921_378_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	378	0		29	10	S5921_378_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	378	0		29	10	S5921_378_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	379	0		29	10	S5921_379_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	379	0		29	10	S5921_379_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	379	0		29	10	S5921_379_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	379	0		29	10	S5921_379_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	379	0		29	10	S5921_379_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	380	0		29	10	S5921_380_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	380	0		29	10	S5921_380_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	380	0		29	10	S5921_380_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	380	0		29	10	S5921_380_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	380	0		29	10	S5921_380_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	381	0		29	10	S5921_381_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	381	0		29	10	S5921_381_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5921	381	0		29	10	S5921_381_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	381	0		29	10	S5921_381_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	381	0		29	10	S5921_381_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	382	0		29	10	S5921_382_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	382	0		29	10	S5921_382_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	382	0		29	10	S5921_382_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	382	0		29	10	S5921_382_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	382	0		29	10	S5921_382_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	383	0		29	10	S5921_383_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	383	0		29	10	S5921_383_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	383	0		29	10	S5921_383_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	383	0		29	10	S5921_383_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	383	0		29	10	S5921_383_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	384	0		29	10	S5921_384_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	384	0		29	10	S5921_384_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	384	0		29	10	S5921_384_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	384	0		29	10	S5921_384_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	384	0		29	10	S5921_384_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	385	0		29	10	S5921_385_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	385	0		29	10	S5921_385_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	385	0		29	10	S5921_385_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	385	0		29	10	S5921_385_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	385	0		29	10	S5921_385_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	386	0		29	10	S5921_386_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	386	0		29	10	S5921_386_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	386	0		29	10	S5921_386_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	386	0		29	10	S5921_386_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	386	0		29	10	S5921_386_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	387	0		29	10	S5921_387_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	387	0		29	10	S5921_387_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	387	0		29	10	S5921_387_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	387	0		29	10	S5921_387_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	387	0		29	10	S5921_387_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	388	0		29	10	S5921_388_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	388	0		29	10	S5921_388_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	388	0		29	10	S5921_388_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	388	0		29	10	S5921_388_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	388	0		29	10	S5921_388_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	389	0		29	10	S5921_389_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	389	0		29	10	S5921_389_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	389	0		29	10	S5921_389_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	389	0		29	10	S5921_389_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	389	0		29	10	S5921_389_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	390	0		29	10	S5921_390_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	390	0		29	10	S5921_390_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	390	0		29	10	S5921_390_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	390	0		29	10	S5921_390_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	390	0		29	10	S5921_390_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	391	0		29	10	S5921_391_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	391	0		29	10	S5921_391_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	391	0		29	10	S5921_391_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	391	0		29	10	S5921_391_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	391	0		29	10	S5921_391_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	392	0		29	10	S5921_392_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	392	0		29	10	S5921_392_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	392	0		29	10	S5921_392_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	392	0		29	10	S5921_392_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	392	0		29	10	S5921_392_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	393	0		29	10	S5921_393_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	393	0		29	10	S5921_393_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	393	0		29	10	S5921_393_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	393	0		29	10	S5921_393_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	393	0		29	10	S5921_393_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	394	0		29	10	S5921_394_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	394	0		29	10	S5921_394_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	394	0		29	10	S5921_394_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	394	0		29	10	S5921_394_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	394	0		29	10	S5921_394_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	395	0		29	10	S5921_395_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	395	0		29	10	S5921_395_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	395	0		29	10	S5921_395_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	395	0		29	10	S5921_395_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	395	0		29	10	S5921_395_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	396	0		29	10	S5921_396_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	396	0		29	10	S5921_396_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	396	0		29	10	S5921_396_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	396	0		29	10	S5921_396_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	396	0		29	10	S5921_396_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	397	0		29	10	S5921_397_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	397	0		29	10	S5921_397_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	397	0		29	10	S5921_397_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	397	0		29	10	S5921_397_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	397	0		29	10	S5921_397_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	398	0		29	10	S5921_398_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	398	0		29	10	S5921_398_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	398	0		29	10	S5921_398_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	398	0		29	10	S5921_398_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	398	0		29	10	S5921_398_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	399	0		29	10	S5921_399_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	399	0		29	10	S5921_399_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	399	0		29	10	S5921_399_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	399	0		29	10	S5921_399_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	399	0		29	10	S5921_399_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	400	0		29	10	S5921_400_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	400	0		29	10	S5921_400_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	400	0		29	10	S5921_400_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	400	0		29	10	S5921_400_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	400	0		29	10	S5921_400_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	401	0		29	10	S5921_401_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	401	0		29	10	S5921_401_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	401	0		29	10	S5921_401_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	401	0		29	10	S5921_401_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	401	0		29	10	S5921_401_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	402	0		29	10	S5921_402_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	402	0		29	10	S5921_402_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	402	0		29	10	S5921_402_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	402	0		29	10	S5921_402_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	402	0		29	10	S5921_402_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	403	0		29	10	S5921_403_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	403	0		29	10	S5921_403_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	403	0		29	10	S5921_403_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	403	0		29	10	S5921_403_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	403	0		29	10	S5921_403_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	404	0		29	10	S5921_404_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	404	0		29	10	S5921_404_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	404	0		29	10	S5921_404_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	404	0		29	10	S5921_404_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	404	0		29	10	S5921_404_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	405	0		29	10	S5921_405_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	405	0		29	10	S5921_405_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	405	0		29	10	S5921_405_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	405	0		29	10	S5921_405_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	405	0		29	10	S5921_405_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	406	0		29	10	S5921_406_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	406	0		29	10	S5921_406_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	406	0		29	10	S5921_406_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	406	0		29	10	S5921_406_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	406	0		29	10	S5921_406_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	407	0		29	10	S5921_407_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	407	0		29	10	S5921_407_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	407	0		29	10	S5921_407_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	407	0		29	10	S5921_407_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	407	0		29	10	S5921_407_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	408	0		29	10	S5921_408_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	408	0		29	10	S5921_408_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	408	0		29	10	S5921_408_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	408	0		29	10	S5921_408_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	408	0		29	10	S5921_408_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	409	0		29	10	S5921_409_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	409	0		29	10	S5921_409_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	409	0		29	10	S5921_409_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	409	0		29	10	S5921_409_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	409	0		29	10	S5921_409_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	410	0		29	10	S5921_410_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	410	0		29	10	S5921_410_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	410	0		29	10	S5921_410_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	410	0		29	10	S5921_410_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	410	0		29	10	S5921_410_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	411	0		29	10	S5921_411_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	411	0		29	10	S5921_411_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	411	0		29	10	S5921_411_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	411	0		29	10	S5921_411_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	411	0		29	10	S5921_411_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	412	0		29	10	S5921_412_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	412	0		29	10	S5921_412_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	412	0		29	10	S5921_412_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	412	0		29	10	S5921_412_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	412	0		29	10	S5921_412_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	413	0		29	10	S5921_413_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	413	0		29	10	S5921_413_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	413	0		29	10	S5921_413_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	413	0		29	10	S5921_413_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	413	0		29	10	S5921_413_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	414	0		29	10	S5921_414_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	414	0		29	10	S5921_414_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	414	0		29	10	S5921_414_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	414	0		29	10	S5921_414_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	414	0		29	10	S5921_414_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5921	415	0		29	10	S5921_415_0	2	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5921	415	0		29	10	S5921_415_0	2	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	3						
S5921	415	0		29	10	S5921_415_0	2	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5921	415	0		29	10	S5921_415_0	2	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5921	415	0		29	10	S5921_415_0	2	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5953	001	0		29	10	S5953_001_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5953	001	0		29	10	S5953_001_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5953	001	0		29	10	S5953_001_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5953	001	0		29	10	S5953_001_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5953	001	0		29	10	S5953_001_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5953	002	0		29	10	S5953_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5953	002	0		29	10	S5953_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5953	002	0		29	10	S5953_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5953	002	0		29	10	S5953_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5953	002	0		29	10	S5953_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5960	167	0		29	10	S5960_167_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5960	167	0		29	10	S5960_167_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5960	167	0		29	10	S5960_167_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5960	167	0		29	10	S5960_167_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5960	167	0		29	10	S5960_167_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5966	003	0		29	10	S5966_003_0	5	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5966	003	0		29	10	S5966_003_0	5	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5966	003	0		29	10	S5966_003_0	5	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S5966	003	0		29	10	S5966_003_0	5	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5966	003	0		29	10	S5966_003_0	5	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5966	004	0		29	10	S5966_004_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5966	004	0		29	10	S5966_004_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5966	004	0		29	10	S5966_004_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S5966	004	0		29	10	S5966_004_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5966	004	0		29	10	S5966_004_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5983	004	0		29	10	S5983_004_0	2	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5983	004	0		29	10	S5983_004_0	2	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5983	004	0		29	10	S5983_004_0	2	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5983	004	0		29	10	S5983_004_0	2	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5983	004	0		29	10	S5983_004_0	2	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5983	004	0		29	10	S5983_004_0	2	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5983	006	0		29	10	S5983_006_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S5983	006	0		29	10	S5983_006_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S5983	006	0		29	10	S5983_006_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	11	1						
S5983	006	0		29	10	S5983_006_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S5983	006	0		29	10	S5983_006_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S5983	006	0		29	10	S5983_006_0	1	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	11	1						
S5983	007	0		29	10	S5983_007_0	5	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5983	007	0		29	10	S5983_007_0	5	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5983	007	0		29	10	S5983_007_0	5	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5983	007	0		29	10	S5983_007_0	5	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5983	007	0		29	10	S5983_007_0	5	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5993	001	0		29	10	S5993_001_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5993	001	0		29	10	S5993_001_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5993	001	0		29	10	S5993_001_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5993	001	0		29	10	S5993_001_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5993	001	0		29	10	S5993_001_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5993	003	0		29	10	S5993_003_0	6	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5993	003	0		29	10	S5993_003_0	6	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5993	003	0		29	10	S5993_003_0	6	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5993	003	0		29	10	S5993_003_0	6	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5993	003	0		29	10	S5993_003_0	6	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S5993	007	0		29	10	S5993_007_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S5993	007	0		29	10	S5993_007_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S5993	007	0		29	10	S5993_007_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S5993	007	0		29	10	S5993_007_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S5993	007	0		29	10	S5993_007_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6506	001	0		29	10	S6506_001_0	8	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
S6506	001	0		29	10	S6506_001_0	8	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
S6506	001	0		29	10	S6506_001_0	8	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
S6506	001	0		29	10	S6506_001_0	8	Non-Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
S6506	001	0		29	10	S6506_001_0	8	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
S6506	002	0		29	10	S6506_002_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
S6506	002	0		29	10	S6506_002_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
S6506	002	0		29	10	S6506_002_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
S6506	002	0		29	10	S6506_002_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
S6506	002	0		29	10	S6506_002_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
S6506	003	0		29	10	S6506_003_0	8	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1	2	01	1						
S6506	003	0		29	10	S6506_003_0	8	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	2	2	01	1						
S6506	003	0		29	10	S6506_003_0	8	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	3	2	10	1						
S6506	003	0		29	10	S6506_003_0	8	Non-Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	4	2	10	1						
S6506	003	0		29	10	S6506_003_0	8	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	5	2	11	1						
S6946	001	0		29	10	S6946_001_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	001	0		29	10	S6946_001_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	001	0		29	10	S6946_001_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	001	0		29	10	S6946_001_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	001	0		29	10	S6946_001_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	002	0		29	10	S6946_002_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	002	0		29	10	S6946_002_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	002	0		29	10	S6946_002_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	002	0		29	10	S6946_002_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	002	0		29	10	S6946_002_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	003	0		29	10	S6946_003_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	003	0		29	10	S6946_003_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	003	0		29	10	S6946_003_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	003	0		29	10	S6946_003_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	003	0		29	10	S6946_003_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	004	0		29	10	S6946_004_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	004	0		29	10	S6946_004_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	004	0		29	10	S6946_004_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	004	0		29	10	S6946_004_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	004	0		29	10	S6946_004_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	005	0		29	10	S6946_005_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	005	0		29	10	S6946_005_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	005	0		29	10	S6946_005_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	005	0		29	10	S6946_005_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	005	0		29	10	S6946_005_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	006	0		29	10	S6946_006_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	006	0		29	10	S6946_006_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	006	0		29	10	S6946_006_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	006	0		29	10	S6946_006_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	006	0		29	10	S6946_006_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	007	0		29	10	S6946_007_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	007	0		29	10	S6946_007_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	007	0		29	10	S6946_007_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	007	0		29	10	S6946_007_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	007	0		29	10	S6946_007_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	008	0		29	10	S6946_008_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	008	0		29	10	S6946_008_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	008	0		29	10	S6946_008_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	008	0		29	10	S6946_008_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	008	0		29	10	S6946_008_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	009	0		29	10	S6946_009_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	009	0		29	10	S6946_009_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	009	0		29	10	S6946_009_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	009	0		29	10	S6946_009_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	009	0		29	10	S6946_009_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	010	0		29	10	S6946_010_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	010	0		29	10	S6946_010_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	010	0		29	10	S6946_010_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	010	0		29	10	S6946_010_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	010	0		29	10	S6946_010_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	011	0		29	10	S6946_011_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	011	0		29	10	S6946_011_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	011	0		29	10	S6946_011_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	011	0		29	10	S6946_011_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	011	0		29	10	S6946_011_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	012	0		29	10	S6946_012_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	012	0		29	10	S6946_012_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	012	0		29	10	S6946_012_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	012	0		29	10	S6946_012_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	012	0		29	10	S6946_012_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	013	0		29	10	S6946_013_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	013	0		29	10	S6946_013_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	013	0		29	10	S6946_013_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	013	0		29	10	S6946_013_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	013	0		29	10	S6946_013_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	014	0		29	10	S6946_014_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	014	0		29	10	S6946_014_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	014	0		29	10	S6946_014_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	014	0		29	10	S6946_014_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	014	0		29	10	S6946_014_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	015	0		29	10	S6946_015_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	015	0		29	10	S6946_015_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	015	0		29	10	S6946_015_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	015	0		29	10	S6946_015_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	015	0		29	10	S6946_015_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	016	0		29	10	S6946_016_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	016	0		29	10	S6946_016_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	016	0		29	10	S6946_016_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	016	0		29	10	S6946_016_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	016	0		29	10	S6946_016_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	017	0		29	10	S6946_017_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	017	0		29	10	S6946_017_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	017	0		29	10	S6946_017_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	017	0		29	10	S6946_017_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	017	0		29	10	S6946_017_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	018	0		29	10	S6946_018_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	018	0		29	10	S6946_018_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	018	0		29	10	S6946_018_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	018	0		29	10	S6946_018_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	018	0		29	10	S6946_018_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	019	0		29	10	S6946_019_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	019	0		29	10	S6946_019_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	019	0		29	10	S6946_019_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	019	0		29	10	S6946_019_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	019	0		29	10	S6946_019_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	020	0		29	10	S6946_020_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	020	0		29	10	S6946_020_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	020	0		29	10	S6946_020_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	020	0		29	10	S6946_020_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	020	0		29	10	S6946_020_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	021	0		29	10	S6946_021_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	021	0		29	10	S6946_021_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	021	0		29	10	S6946_021_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	021	0		29	10	S6946_021_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	021	0		29	10	S6946_021_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	022	0		29	10	S6946_022_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	022	0		29	10	S6946_022_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	022	0		29	10	S6946_022_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	022	0		29	10	S6946_022_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	022	0		29	10	S6946_022_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	023	0		29	10	S6946_023_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	023	0		29	10	S6946_023_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	023	0		29	10	S6946_023_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	023	0		29	10	S6946_023_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	023	0		29	10	S6946_023_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	024	0		29	10	S6946_024_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	024	0		29	10	S6946_024_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	024	0		29	10	S6946_024_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	024	0		29	10	S6946_024_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	024	0		29	10	S6946_024_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	025	0		29	10	S6946_025_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	025	0		29	10	S6946_025_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	025	0		29	10	S6946_025_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	025	0		29	10	S6946_025_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	025	0		29	10	S6946_025_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	026	0		29	10	S6946_026_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	026	0		29	10	S6946_026_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	026	0		29	10	S6946_026_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	026	0		29	10	S6946_026_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	026	0		29	10	S6946_026_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	027	0		29	10	S6946_027_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	027	0		29	10	S6946_027_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	027	0		29	10	S6946_027_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	027	0		29	10	S6946_027_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	027	0		29	10	S6946_027_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	028	0		29	10	S6946_028_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	028	0		29	10	S6946_028_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	028	0		29	10	S6946_028_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	028	0		29	10	S6946_028_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	028	0		29	10	S6946_028_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	029	0		29	10	S6946_029_0	4	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	029	0		29	10	S6946_029_0	4	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	029	0		29	10	S6946_029_0	4	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	029	0		29	10	S6946_029_0	4	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	029	0		29	10	S6946_029_0	4	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	030	0		29	10	S6946_030_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	030	0		29	10	S6946_030_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	030	0		29	10	S6946_030_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	030	0		29	10	S6946_030_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	030	0		29	10	S6946_030_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	031	0		29	10	S6946_031_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	031	0		29	10	S6946_031_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	031	0		29	10	S6946_031_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	031	0		29	10	S6946_031_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	031	0		29	10	S6946_031_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	032	0		29	10	S6946_032_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	032	0		29	10	S6946_032_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	032	0		29	10	S6946_032_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	032	0		29	10	S6946_032_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	032	0		29	10	S6946_032_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	033	0		29	10	S6946_033_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	033	0		29	10	S6946_033_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	033	0		29	10	S6946_033_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	033	0		29	10	S6946_033_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	033	0		29	10	S6946_033_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	034	0		29	10	S6946_034_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	034	0		29	10	S6946_034_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	034	0		29	10	S6946_034_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	034	0		29	10	S6946_034_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	034	0		29	10	S6946_034_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	035	0		29	10	S6946_035_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	035	0		29	10	S6946_035_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	035	0		29	10	S6946_035_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	035	0		29	10	S6946_035_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	035	0		29	10	S6946_035_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	036	0		29	10	S6946_036_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	036	0		29	10	S6946_036_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	036	0		29	10	S6946_036_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	036	0		29	10	S6946_036_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	036	0		29	10	S6946_036_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	037	0		29	10	S6946_037_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	037	0		29	10	S6946_037_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	037	0		29	10	S6946_037_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	037	0		29	10	S6946_037_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	037	0		29	10	S6946_037_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	038	0		29	10	S6946_038_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	038	0		29	10	S6946_038_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	038	0		29	10	S6946_038_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	038	0		29	10	S6946_038_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	038	0		29	10	S6946_038_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	039	0		29	10	S6946_039_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	039	0		29	10	S6946_039_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	039	0		29	10	S6946_039_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	039	0		29	10	S6946_039_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	039	0		29	10	S6946_039_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	040	0		29	10	S6946_040_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	040	0		29	10	S6946_040_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	040	0		29	10	S6946_040_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	040	0		29	10	S6946_040_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	040	0		29	10	S6946_040_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	041	0		29	10	S6946_041_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	041	0		29	10	S6946_041_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	041	0		29	10	S6946_041_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	041	0		29	10	S6946_041_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	041	0		29	10	S6946_041_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	042	0		29	10	S6946_042_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	042	0		29	10	S6946_042_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	042	0		29	10	S6946_042_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	042	0		29	10	S6946_042_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	042	0		29	10	S6946_042_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	043	0		29	10	S6946_043_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	043	0		29	10	S6946_043_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	043	0		29	10	S6946_043_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	043	0		29	10	S6946_043_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	043	0		29	10	S6946_043_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	044	0		29	10	S6946_044_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	044	0		29	10	S6946_044_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	044	0		29	10	S6946_044_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	044	0		29	10	S6946_044_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	044	0		29	10	S6946_044_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	045	0		29	10	S6946_045_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	045	0		29	10	S6946_045_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	045	0		29	10	S6946_045_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	045	0		29	10	S6946_045_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	045	0		29	10	S6946_045_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	046	0		29	10	S6946_046_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	046	0		29	10	S6946_046_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	046	0		29	10	S6946_046_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	046	0		29	10	S6946_046_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	046	0		29	10	S6946_046_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	047	0		29	10	S6946_047_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	047	0		29	10	S6946_047_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	047	0		29	10	S6946_047_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	047	0		29	10	S6946_047_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	047	0		29	10	S6946_047_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	048	0		29	10	S6946_048_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	048	0		29	10	S6946_048_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	048	0		29	10	S6946_048_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	048	0		29	10	S6946_048_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	048	0		29	10	S6946_048_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	049	0		29	10	S6946_049_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	049	0		29	10	S6946_049_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	049	0		29	10	S6946_049_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	049	0		29	10	S6946_049_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	049	0		29	10	S6946_049_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	050	0		29	10	S6946_050_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	050	0		29	10	S6946_050_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	050	0		29	10	S6946_050_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	050	0		29	10	S6946_050_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	050	0		29	10	S6946_050_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	051	0		29	10	S6946_051_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	051	0		29	10	S6946_051_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	051	0		29	10	S6946_051_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	051	0		29	10	S6946_051_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	051	0		29	10	S6946_051_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	052	0		29	10	S6946_052_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	052	0		29	10	S6946_052_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	052	0		29	10	S6946_052_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	052	0		29	10	S6946_052_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	052	0		29	10	S6946_052_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	053	0		29	10	S6946_053_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	053	0		29	10	S6946_053_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	053	0		29	10	S6946_053_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	053	0		29	10	S6946_053_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	053	0		29	10	S6946_053_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	054	0		29	10	S6946_054_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	054	0		29	10	S6946_054_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	054	0		29	10	S6946_054_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	054	0		29	10	S6946_054_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	054	0		29	10	S6946_054_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	055	0		29	10	S6946_055_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	055	0		29	10	S6946_055_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	055	0		29	10	S6946_055_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	055	0		29	10	S6946_055_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	055	0		29	10	S6946_055_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	056	0		29	10	S6946_056_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	056	0		29	10	S6946_056_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	056	0		29	10	S6946_056_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	056	0		29	10	S6946_056_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	056	0		29	10	S6946_056_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	057	0		29	10	S6946_057_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	057	0		29	10	S6946_057_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	057	0		29	10	S6946_057_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	057	0		29	10	S6946_057_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	057	0		29	10	S6946_057_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S6946	058	0		29	10	S6946_058_0	4	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S6946	058	0		29	10	S6946_058_0	4	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S6946	058	0		29	10	S6946_058_0	4	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S6946	058	0		29	10	S6946_058_0	4	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	10	1						
S6946	058	0		29	10	S6946_058_0	4	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	001	0		29	10	S7126_001_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	001	0		29	10	S7126_001_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	001	0		29	10	S7126_001_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	001	0		29	10	S7126_001_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	001	0		29	10	S7126_001_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	002	0		29	10	S7126_002_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	002	0		29	10	S7126_002_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	002	0		29	10	S7126_002_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	002	0		29	10	S7126_002_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	002	0		29	10	S7126_002_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	003	0		29	10	S7126_003_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	003	0		29	10	S7126_003_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	003	0		29	10	S7126_003_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	003	0		29	10	S7126_003_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	003	0		29	10	S7126_003_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	004	0		29	10	S7126_004_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	004	0		29	10	S7126_004_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	004	0		29	10	S7126_004_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	004	0		29	10	S7126_004_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	004	0		29	10	S7126_004_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	005	0		29	10	S7126_005_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	005	0		29	10	S7126_005_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	005	0		29	10	S7126_005_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	005	0		29	10	S7126_005_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	005	0		29	10	S7126_005_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	006	0		29	10	S7126_006_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	006	0		29	10	S7126_006_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	006	0		29	10	S7126_006_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	006	0		29	10	S7126_006_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	006	0		29	10	S7126_006_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	007	0		29	10	S7126_007_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	007	0		29	10	S7126_007_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	007	0		29	10	S7126_007_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	007	0		29	10	S7126_007_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	007	0		29	10	S7126_007_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	008	0		29	10	S7126_008_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	008	0		29	10	S7126_008_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	008	0		29	10	S7126_008_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	008	0		29	10	S7126_008_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	008	0		29	10	S7126_008_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	009	0		29	10	S7126_009_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	009	0		29	10	S7126_009_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	009	0		29	10	S7126_009_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	009	0		29	10	S7126_009_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	009	0		29	10	S7126_009_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	010	0		29	10	S7126_010_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	010	0		29	10	S7126_010_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	010	0		29	10	S7126_010_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	010	0		29	10	S7126_010_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	010	0		29	10	S7126_010_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	011	0		29	10	S7126_011_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	011	0		29	10	S7126_011_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	011	0		29	10	S7126_011_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	011	0		29	10	S7126_011_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	011	0		29	10	S7126_011_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	012	0		29	10	S7126_012_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	012	0		29	10	S7126_012_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	012	0		29	10	S7126_012_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	012	0		29	10	S7126_012_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	012	0		29	10	S7126_012_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	013	0		29	10	S7126_013_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	013	0		29	10	S7126_013_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	013	0		29	10	S7126_013_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	013	0		29	10	S7126_013_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	013	0		29	10	S7126_013_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	014	0		29	10	S7126_014_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	014	0		29	10	S7126_014_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	014	0		29	10	S7126_014_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	014	0		29	10	S7126_014_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	014	0		29	10	S7126_014_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	015	0		29	10	S7126_015_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	015	0		29	10	S7126_015_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	015	0		29	10	S7126_015_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	015	0		29	10	S7126_015_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	015	0		29	10	S7126_015_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	016	0		29	10	S7126_016_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	016	0		29	10	S7126_016_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	016	0		29	10	S7126_016_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	016	0		29	10	S7126_016_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	016	0		29	10	S7126_016_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	017	0		29	10	S7126_017_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	017	0		29	10	S7126_017_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	017	0		29	10	S7126_017_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	017	0		29	10	S7126_017_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	017	0		29	10	S7126_017_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	018	0		29	10	S7126_018_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	018	0		29	10	S7126_018_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	018	0		29	10	S7126_018_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	018	0		29	10	S7126_018_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	018	0		29	10	S7126_018_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	019	0		29	10	S7126_019_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	019	0		29	10	S7126_019_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	019	0		29	10	S7126_019_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	019	0		29	10	S7126_019_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	019	0		29	10	S7126_019_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	020	0		29	10	S7126_020_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	020	0		29	10	S7126_020_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	020	0		29	10	S7126_020_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	020	0		29	10	S7126_020_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	020	0		29	10	S7126_020_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	021	0		29	10	S7126_021_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	021	0		29	10	S7126_021_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	021	0		29	10	S7126_021_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	021	0		29	10	S7126_021_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	021	0		29	10	S7126_021_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	022	0		29	10	S7126_022_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	022	0		29	10	S7126_022_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	022	0		29	10	S7126_022_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	022	0		29	10	S7126_022_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	022	0		29	10	S7126_022_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	023	0		29	10	S7126_023_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	023	0		29	10	S7126_023_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	023	0		29	10	S7126_023_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	023	0		29	10	S7126_023_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	023	0		29	10	S7126_023_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	024	0		29	10	S7126_024_0	3	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	024	0		29	10	S7126_024_0	3	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	024	0		29	10	S7126_024_0	3	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	024	0		29	10	S7126_024_0	3	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	024	0		29	10	S7126_024_0	3	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	025	0		29	10	S7126_025_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	025	0		29	10	S7126_025_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	025	0		29	10	S7126_025_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	025	0		29	10	S7126_025_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	025	0		29	10	S7126_025_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	026	0		29	10	S7126_026_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	026	0		29	10	S7126_026_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	026	0		29	10	S7126_026_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	026	0		29	10	S7126_026_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	026	0		29	10	S7126_026_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	027	0		29	10	S7126_027_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	027	0		29	10	S7126_027_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	027	0		29	10	S7126_027_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	027	0		29	10	S7126_027_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	027	0		29	10	S7126_027_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	028	0		29	10	S7126_028_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	028	0		29	10	S7126_028_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	028	0		29	10	S7126_028_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	028	0		29	10	S7126_028_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	028	0		29	10	S7126_028_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	029	0		29	10	S7126_029_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	029	0		29	10	S7126_029_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	029	0		29	10	S7126_029_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	029	0		29	10	S7126_029_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	029	0		29	10	S7126_029_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	030	0		29	10	S7126_030_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	030	0		29	10	S7126_030_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	030	0		29	10	S7126_030_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	030	0		29	10	S7126_030_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	030	0		29	10	S7126_030_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	031	0		29	10	S7126_031_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	031	0		29	10	S7126_031_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	031	0		29	10	S7126_031_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	031	0		29	10	S7126_031_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	031	0		29	10	S7126_031_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	032	0		29	10	S7126_032_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	032	0		29	10	S7126_032_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	032	0		29	10	S7126_032_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	032	0		29	10	S7126_032_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	032	0		29	10	S7126_032_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	033	0		29	10	S7126_033_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	033	0		29	10	S7126_033_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	033	0		29	10	S7126_033_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	033	0		29	10	S7126_033_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	033	0		29	10	S7126_033_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	071	0		29	10	S7126_071_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	071	0		29	10	S7126_071_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	071	0		29	10	S7126_071_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	071	0		29	10	S7126_071_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	071	0		29	10	S7126_071_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	072	0		29	10	S7126_072_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	072	0		29	10	S7126_072_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	072	0		29	10	S7126_072_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	072	0		29	10	S7126_072_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	072	0		29	10	S7126_072_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	073	0		29	10	S7126_073_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	073	0		29	10	S7126_073_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	073	0		29	10	S7126_073_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	073	0		29	10	S7126_073_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	073	0		29	10	S7126_073_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	074	0		29	10	S7126_074_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	074	0		29	10	S7126_074_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	074	0		29	10	S7126_074_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	074	0		29	10	S7126_074_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	074	0		29	10	S7126_074_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	075	0		29	10	S7126_075_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	075	0		29	10	S7126_075_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	075	0		29	10	S7126_075_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	075	0		29	10	S7126_075_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	075	0		29	10	S7126_075_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	076	0		29	10	S7126_076_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	076	0		29	10	S7126_076_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	076	0		29	10	S7126_076_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	076	0		29	10	S7126_076_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	076	0		29	10	S7126_076_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	077	0		29	10	S7126_077_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	077	0		29	10	S7126_077_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	077	0		29	10	S7126_077_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	077	0		29	10	S7126_077_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	077	0		29	10	S7126_077_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	078	0		29	10	S7126_078_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	078	0		29	10	S7126_078_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	078	0		29	10	S7126_078_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	078	0		29	10	S7126_078_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	078	0		29	10	S7126_078_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	079	0		29	10	S7126_079_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	079	0		29	10	S7126_079_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	079	0		29	10	S7126_079_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	079	0		29	10	S7126_079_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	079	0		29	10	S7126_079_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	080	0		29	10	S7126_080_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	080	0		29	10	S7126_080_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	080	0		29	10	S7126_080_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	080	0		29	10	S7126_080_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	080	0		29	10	S7126_080_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	081	0		29	10	S7126_081_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	081	0		29	10	S7126_081_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	081	0		29	10	S7126_081_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	081	0		29	10	S7126_081_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	081	0		29	10	S7126_081_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	082	0		29	10	S7126_082_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	082	0		29	10	S7126_082_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	082	0		29	10	S7126_082_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	082	0		29	10	S7126_082_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	082	0		29	10	S7126_082_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	083	0		29	10	S7126_083_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	083	0		29	10	S7126_083_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	083	0		29	10	S7126_083_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	083	0		29	10	S7126_083_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	083	0		29	10	S7126_083_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	084	0		29	10	S7126_084_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	084	0		29	10	S7126_084_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	084	0		29	10	S7126_084_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	084	0		29	10	S7126_084_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	084	0		29	10	S7126_084_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	085	0		29	10	S7126_085_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	085	0		29	10	S7126_085_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	085	0		29	10	S7126_085_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	085	0		29	10	S7126_085_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	085	0		29	10	S7126_085_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	086	0		29	10	S7126_086_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	086	0		29	10	S7126_086_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	086	0		29	10	S7126_086_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	086	0		29	10	S7126_086_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	086	0		29	10	S7126_086_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	087	0		29	10	S7126_087_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	087	0		29	10	S7126_087_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	087	0		29	10	S7126_087_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	087	0		29	10	S7126_087_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	087	0		29	10	S7126_087_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	088	0		29	10	S7126_088_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	088	0		29	10	S7126_088_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	088	0		29	10	S7126_088_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	088	0		29	10	S7126_088_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	088	0		29	10	S7126_088_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	089	0		29	10	S7126_089_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	089	0		29	10	S7126_089_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	089	0		29	10	S7126_089_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	089	0		29	10	S7126_089_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	089	0		29	10	S7126_089_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	090	0		29	10	S7126_090_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	090	0		29	10	S7126_090_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	090	0		29	10	S7126_090_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	090	0		29	10	S7126_090_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	090	0		29	10	S7126_090_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	091	0		29	10	S7126_091_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	091	0		29	10	S7126_091_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	091	0		29	10	S7126_091_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	091	0		29	10	S7126_091_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	091	0		29	10	S7126_091_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	092	0		29	10	S7126_092_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	092	0		29	10	S7126_092_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	092	0		29	10	S7126_092_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	092	0		29	10	S7126_092_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	092	0		29	10	S7126_092_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	093	0		29	10	S7126_093_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	093	0		29	10	S7126_093_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	093	0		29	10	S7126_093_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	093	0		29	10	S7126_093_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	093	0		29	10	S7126_093_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	094	0		29	10	S7126_094_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	094	0		29	10	S7126_094_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	094	0		29	10	S7126_094_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	094	0		29	10	S7126_094_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	094	0		29	10	S7126_094_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	095	0		29	10	S7126_095_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	095	0		29	10	S7126_095_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	095	0		29	10	S7126_095_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	095	0		29	10	S7126_095_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	095	0		29	10	S7126_095_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	096	0		29	10	S7126_096_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	096	0		29	10	S7126_096_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	096	0		29	10	S7126_096_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	096	0		29	10	S7126_096_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	096	0		29	10	S7126_096_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	097	0		29	10	S7126_097_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	097	0		29	10	S7126_097_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	097	0		29	10	S7126_097_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	097	0		29	10	S7126_097_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	097	0		29	10	S7126_097_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	098	0		29	10	S7126_098_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	098	0		29	10	S7126_098_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	098	0		29	10	S7126_098_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	098	0		29	10	S7126_098_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	098	0		29	10	S7126_098_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	099	0		29	10	S7126_099_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	099	0		29	10	S7126_099_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	099	0		29	10	S7126_099_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	099	0		29	10	S7126_099_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	099	0		29	10	S7126_099_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	100	0		29	10	S7126_100_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	100	0		29	10	S7126_100_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	100	0		29	10	S7126_100_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	100	0		29	10	S7126_100_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	100	0		29	10	S7126_100_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	101	0		29	10	S7126_101_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	101	0		29	10	S7126_101_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	101	0		29	10	S7126_101_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	101	0		29	10	S7126_101_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	101	0		29	10	S7126_101_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	102	0		29	10	S7126_102_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	102	0		29	10	S7126_102_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	102	0		29	10	S7126_102_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	102	0		29	10	S7126_102_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	102	0		29	10	S7126_102_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7126	103	0		29	10	S7126_103_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7126	103	0		29	10	S7126_103_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7126	103	0		29	10	S7126_103_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7126	103	0		29	10	S7126_103_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7126	103	0		29	10	S7126_103_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	001	0		29	10	S7694_001_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	001	0		29	10	S7694_001_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	001	0		29	10	S7694_001_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	001	0		29	10	S7694_001_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	001	0		29	10	S7694_001_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	002	0		29	10	S7694_002_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	002	0		29	10	S7694_002_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	002	0		29	10	S7694_002_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	002	0		29	10	S7694_002_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	002	0		29	10	S7694_002_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	003	0		29	10	S7694_003_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	003	0		29	10	S7694_003_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	003	0		29	10	S7694_003_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	003	0		29	10	S7694_003_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	003	0		29	10	S7694_003_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	004	0		29	10	S7694_004_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	004	0		29	10	S7694_004_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	004	0		29	10	S7694_004_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	004	0		29	10	S7694_004_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	004	0		29	10	S7694_004_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	005	0		29	10	S7694_005_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	005	0		29	10	S7694_005_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	005	0		29	10	S7694_005_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	005	0		29	10	S7694_005_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	005	0		29	10	S7694_005_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	006	0		29	10	S7694_006_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	006	0		29	10	S7694_006_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	006	0		29	10	S7694_006_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	006	0		29	10	S7694_006_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	006	0		29	10	S7694_006_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	007	0		29	10	S7694_007_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	007	0		29	10	S7694_007_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	007	0		29	10	S7694_007_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	007	0		29	10	S7694_007_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	007	0		29	10	S7694_007_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	008	0		29	10	S7694_008_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	008	0		29	10	S7694_008_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	008	0		29	10	S7694_008_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	008	0		29	10	S7694_008_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	008	0		29	10	S7694_008_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	009	0		29	10	S7694_009_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	009	0		29	10	S7694_009_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	009	0		29	10	S7694_009_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	009	0		29	10	S7694_009_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	009	0		29	10	S7694_009_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	010	0		29	10	S7694_010_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	010	0		29	10	S7694_010_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	010	0		29	10	S7694_010_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	010	0		29	10	S7694_010_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	010	0		29	10	S7694_010_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	011	0		29	10	S7694_011_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	011	0		29	10	S7694_011_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	011	0		29	10	S7694_011_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	011	0		29	10	S7694_011_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	011	0		29	10	S7694_011_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	012	0		29	10	S7694_012_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	012	0		29	10	S7694_012_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	012	0		29	10	S7694_012_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	012	0		29	10	S7694_012_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	012	0		29	10	S7694_012_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	014	0		29	10	S7694_014_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	014	0		29	10	S7694_014_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	014	0		29	10	S7694_014_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	014	0		29	10	S7694_014_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	014	0		29	10	S7694_014_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	015	0		29	10	S7694_015_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	015	0		29	10	S7694_015_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	015	0		29	10	S7694_015_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	015	0		29	10	S7694_015_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	015	0		29	10	S7694_015_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	016	0		29	10	S7694_016_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	016	0		29	10	S7694_016_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	016	0		29	10	S7694_016_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	016	0		29	10	S7694_016_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	016	0		29	10	S7694_016_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	017	0		29	10	S7694_017_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	017	0		29	10	S7694_017_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	017	0		29	10	S7694_017_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	017	0		29	10	S7694_017_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	017	0		29	10	S7694_017_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	018	0		29	10	S7694_018_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	018	0		29	10	S7694_018_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	018	0		29	10	S7694_018_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	018	0		29	10	S7694_018_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	018	0		29	10	S7694_018_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	019	0		29	10	S7694_019_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	019	0		29	10	S7694_019_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	019	0		29	10	S7694_019_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	019	0		29	10	S7694_019_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	019	0		29	10	S7694_019_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	020	0		29	10	S7694_020_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	020	0		29	10	S7694_020_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	020	0		29	10	S7694_020_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	020	0		29	10	S7694_020_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	020	0		29	10	S7694_020_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	021	0		29	10	S7694_021_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	021	0		29	10	S7694_021_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	021	0		29	10	S7694_021_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	021	0		29	10	S7694_021_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	021	0		29	10	S7694_021_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	022	0		29	10	S7694_022_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	022	0		29	10	S7694_022_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	022	0		29	10	S7694_022_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	022	0		29	10	S7694_022_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	022	0		29	10	S7694_022_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	023	0		29	10	S7694_023_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	023	0		29	10	S7694_023_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	023	0		29	10	S7694_023_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	023	0		29	10	S7694_023_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	023	0		29	10	S7694_023_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	024	0		29	10	S7694_024_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	024	0		29	10	S7694_024_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	024	0		29	10	S7694_024_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	024	0		29	10	S7694_024_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	024	0		29	10	S7694_024_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	025	0		29	10	S7694_025_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	025	0		29	10	S7694_025_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	025	0		29	10	S7694_025_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	025	0		29	10	S7694_025_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	025	0		29	10	S7694_025_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	026	0		29	10	S7694_026_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	026	0		29	10	S7694_026_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	026	0		29	10	S7694_026_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	026	0		29	10	S7694_026_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	026	0		29	10	S7694_026_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	027	0		29	10	S7694_027_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	027	0		29	10	S7694_027_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	027	0		29	10	S7694_027_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	027	0		29	10	S7694_027_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	027	0		29	10	S7694_027_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	028	0		29	10	S7694_028_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	028	0		29	10	S7694_028_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	028	0		29	10	S7694_028_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	028	0		29	10	S7694_028_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	028	0		29	10	S7694_028_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	029	0		29	10	S7694_029_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	029	0		29	10	S7694_029_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	029	0		29	10	S7694_029_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	029	0		29	10	S7694_029_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	029	0		29	10	S7694_029_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	030	0		29	10	S7694_030_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	030	0		29	10	S7694_030_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	030	0		29	10	S7694_030_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	030	0		29	10	S7694_030_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	030	0		29	10	S7694_030_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	031	0		29	10	S7694_031_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	031	0		29	10	S7694_031_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	031	0		29	10	S7694_031_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	031	0		29	10	S7694_031_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	031	0		29	10	S7694_031_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	032	0		29	10	S7694_032_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	032	0		29	10	S7694_032_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	032	0		29	10	S7694_032_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	032	0		29	10	S7694_032_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	032	0		29	10	S7694_032_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	033	0		29	10	S7694_033_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	033	0		29	10	S7694_033_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	033	0		29	10	S7694_033_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	033	0		29	10	S7694_033_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	033	0		29	10	S7694_033_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	034	0		29	10	S7694_034_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	034	0		29	10	S7694_034_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	034	0		29	10	S7694_034_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	034	0		29	10	S7694_034_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	034	0		29	10	S7694_034_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	070	0		29	10	S7694_070_0	1	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	070	0		29	10	S7694_070_0	1	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	070	0		29	10	S7694_070_0	1	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	070	0		29	10	S7694_070_0	1	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	070	0		29	10	S7694_070_0	1	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	105	0		29	10	S7694_105_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	105	0		29	10	S7694_105_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	105	0		29	10	S7694_105_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	105	0		29	10	S7694_105_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	105	0		29	10	S7694_105_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	106	0		29	10	S7694_106_0	2	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	106	0		29	10	S7694_106_0	2	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	106	0		29	10	S7694_106_0	2	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	106	0		29	10	S7694_106_0	2	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	106	0		29	10	S7694_106_0	2	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	121	0		29	10	S7694_121_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	121	0		29	10	S7694_121_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	121	0		29	10	S7694_121_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	121	0		29	10	S7694_121_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	121	0		29	10	S7694_121_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	122	0		29	10	S7694_122_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	122	0		29	10	S7694_122_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	122	0		29	10	S7694_122_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	122	0		29	10	S7694_122_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	122	0		29	10	S7694_122_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	123	0		29	10	S7694_123_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	123	0		29	10	S7694_123_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	123	0		29	10	S7694_123_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	123	0		29	10	S7694_123_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	123	0		29	10	S7694_123_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	124	0		29	10	S7694_124_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	124	0		29	10	S7694_124_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	124	0		29	10	S7694_124_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	124	0		29	10	S7694_124_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	124	0		29	10	S7694_124_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	125	0		29	10	S7694_125_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	125	0		29	10	S7694_125_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	125	0		29	10	S7694_125_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	125	0		29	10	S7694_125_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	125	0		29	10	S7694_125_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	126	0		29	10	S7694_126_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	126	0		29	10	S7694_126_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	126	0		29	10	S7694_126_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	126	0		29	10	S7694_126_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	126	0		29	10	S7694_126_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	127	0		29	10	S7694_127_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	127	0		29	10	S7694_127_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	127	0		29	10	S7694_127_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	127	0		29	10	S7694_127_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	127	0		29	10	S7694_127_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	128	0		29	10	S7694_128_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	128	0		29	10	S7694_128_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	128	0		29	10	S7694_128_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	128	0		29	10	S7694_128_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	128	0		29	10	S7694_128_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	129	0		29	10	S7694_129_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	129	0		29	10	S7694_129_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	129	0		29	10	S7694_129_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	129	0		29	10	S7694_129_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	129	0		29	10	S7694_129_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	130	0		29	10	S7694_130_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	130	0		29	10	S7694_130_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	130	0		29	10	S7694_130_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	130	0		29	10	S7694_130_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	130	0		29	10	S7694_130_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	131	0		29	10	S7694_131_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	131	0		29	10	S7694_131_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	131	0		29	10	S7694_131_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	131	0		29	10	S7694_131_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	131	0		29	10	S7694_131_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	132	0		29	10	S7694_132_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	132	0		29	10	S7694_132_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	132	0		29	10	S7694_132_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	132	0		29	10	S7694_132_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	132	0		29	10	S7694_132_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	133	0		29	10	S7694_133_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	133	0		29	10	S7694_133_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	133	0		29	10	S7694_133_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	133	0		29	10	S7694_133_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	133	0		29	10	S7694_133_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	134	0		29	10	S7694_134_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	134	0		29	10	S7694_134_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	134	0		29	10	S7694_134_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	134	0		29	10	S7694_134_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	134	0		29	10	S7694_134_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	135	0		29	10	S7694_135_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	135	0		29	10	S7694_135_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	135	0		29	10	S7694_135_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	135	0		29	10	S7694_135_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	135	0		29	10	S7694_135_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	136	0		29	10	S7694_136_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	136	0		29	10	S7694_136_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	136	0		29	10	S7694_136_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	136	0		29	10	S7694_136_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	136	0		29	10	S7694_136_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S7694	137	0		29	10	S7694_137_0	1	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S7694	137	0		29	10	S7694_137_0	1	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S7694	137	0		29	10	S7694_137_0	1	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S7694	137	0		29	10	S7694_137_0	1	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S7694	137	0		29	10	S7694_137_0	1	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S8067	001	0		29	10	S8067_001_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S8067	001	0		29	10	S8067_001_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S8067	001	0		29	10	S8067_001_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
S8067	001	0		29	10	S8067_001_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S8067	001	0		29	10	S8067_001_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S8067	001	0		29	10	S8067_001_0	3	Select Care Drugs	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
S8067	003	0		29	10	S8067_003_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	1	2	01	1						
S8067	003	0		29	10	S8067_003_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	2	2	01	1						
S8067	003	0		29	10	S8067_003_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	3	2	10	1						
S8067	003	0		29	10	S8067_003_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	4	2	11	1						
S8067	003	0		29	10	S8067_003_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	5	2	11	1						
S8067	003	0		29	10	S8067_003_0	3	Select Care Drugs	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs	6	2	01	1						
S8182	001	0		29	10	S8182_001_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S8182	001	0		29	10	S8182_001_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S8182	001	0		29	10	S8182_001_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S8182	001	0		29	10	S8182_001_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S8182	001	0		29	10	S8182_001_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S8182	002	0		29	10	S8182_002_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S8182	002	0		29	10	S8182_002_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S8182	002	0		29	10	S8182_002_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S8182	002	0		29	10	S8182_002_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S8182	002	0		29	10	S8182_002_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S8182	003	0		29	10	S8182_003_0	3	Preferred Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S8182	003	0		29	10	S8182_003_0	3	Generic	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S8182	003	0		29	10	S8182_003_0	3	Preferred Brand	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S8182	003	0		29	10	S8182_003_0	3	Non-Preferred Drug	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S8182	003	0		29	10	S8182_003_0	3	Specialty Tier	3	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S8182	004	0		29	10	S8182_004_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S8182	004	0		29	10	S8182_004_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S8182	004	0		29	10	S8182_004_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S8182	004	0		29	10	S8182_004_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S8182	004	0		29	10	S8182_004_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S8182	005	0		29	10	S8182_005_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S8182	005	0		29	10	S8182_005_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S8182	005	0		29	10	S8182_005_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S8182	005	0		29	10	S8182_005_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S8182	005	0		29	10	S8182_005_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S8182	006	0		29	10	S8182_006_0	3	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S8182	006	0		29	10	S8182_006_0	3	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S8182	006	0		29	10	S8182_006_0	3	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	11	1						
S8182	006	0		29	10	S8182_006_0	3	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S8182	006	0		29	10	S8182_006_0	3	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S9325	001	0		29	10	S9325_001_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S9325	001	0		29	10	S9325_001_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S9325	001	0		29	10	S9325_001_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S9325	001	0		29	10	S9325_001_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S9325	001	0		29	10	S9325_001_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S9325	002	0		29	10	S9325_002_0	7	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S9325	002	0		29	10	S9325_002_0	7	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S9325	002	0		29	10	S9325_002_0	7	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S9325	002	0		29	10	S9325_002_0	7	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S9325	002	0		29	10	S9325_002_0	7	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S9325	003	0		29	10	S9325_003_0	9	Preferred Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S9325	003	0		29	10	S9325_003_0	9	Generic	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S9325	003	0		29	10	S9325_003_0	9	Preferred Brand	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S9325	003	0		29	10	S9325_003_0	9	Non-Preferred Drug	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S9325	003	0		29	10	S9325_003_0	9	Specialty Tier	4	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
S9325	004	0		29	10	S9325_004_0	7	Preferred Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	1	2	01	1						
S9325	004	0		29	10	S9325_004_0	7	Generic	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	2	2	01	1						
S9325	004	0		29	10	S9325_004_0	7	Preferred Brand	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	3	2	10	1						
S9325	004	0		29	10	S9325_004_0	7	Non-Preferred Drug	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	4	2	11	1						
S9325	004	0		29	10	S9325_004_0	7	Specialty Tier	2	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier	5	2	11	1						
